Mini-babies

Apparently, blogger just reminded me that this is my 50th post...

After a week home with my family, doing nothing and everything, I came back to main campus for a month in neonatology. Just to remind you that I am looking to go in family med, with an obvious interest in geriatrics much more than ped... So, this rotation was not very high on my list.

The good thing is that it confirms that I am not that much interested in pediatrics, and particularly babies. I have never been very interested in babies, and they don't like me either...  I prefer when they talk and can have a minimum of conversation.

I have to say though that people are very nice. I work with a great senior resident this week. I appreciate the multi-professionnal aspect of this specialty. We round patients with the nurses and the parents when possible, and have a meeting every week with social worker, psychologist and physical therapist involved in the care of our mini-patients. I like to see that we can all work in the same direction for the good of the patient and their family (because this is very often the case, when there is siblings at home).

Still, this month seems very long...

Internal med

Vacation week is just around the corner and I have to say, I am looking forward to it like I never did before (ok, probably not true, because if I remember correctly, last year was even worse!)

I started this rotation still very motivated. After spending a very long 7 hours in the same house than my husband, he left for a week in Europe for work, came back for a week and left again for another 2 weeks... Not a very easy month really... 3 weeks out of 4 being single-mom while on rotation is sub-optimal at best. Luckily for me, Princess is 9 and very resourceful. I let her walk home from day-camp this week, so she is about half-hour alone at home (but I have fantastic neighbour, so she has a place to go if she has any issue). I know I shouldn't do it, but there is just no other way possible.

My rotation is very interesting, with few complex patients and a lot of time to do teaching. We take mostly about 30 to 60 minutes to discuss a subject and organize our differential diagnoses and investigations. I suppose this is my best rotation for learning. Internal medicine is very interesting and the practice is diverse. I suppose I could see myself do that... but, because I am so tired and in need of vacation, I have to say, I am not giving my 100% at the moment. I believe I am not doing too bad but still I am not totally satisfied with myself, but at this point, it will have to do.

I had done critical review about this article on Acetaminophen in chronic pain... Interesting read that made me question how I would use acetaminophen in my future practice (specially since I have an interest on treating chronic pain).

It feels good to be back in my "home hospital" too. To see other physicians on the ward that I know. I love to feel at home, to feel I belong somewhere (not a feeling I had while at the big university-hospital at the main campus).

So, not so bad after all... And then, in the upcoming months, we are going to prepare for CaRMS, apparently a very busy time ahead until mid-november...

Miss Princess

This weekend was all about my Princess.

Just to be fair, even though it was Father's Day weekend, and even though my husband is the most fantastic dad out there, he is gone to Scotland for the week, so there you go, no Father's day celebration for him...

I am incredibly proud of the small adult my Princess is becoming. She is so clever and wise and independant for a nine years-old. For her birthday, she had a slumber-party with four friends from her class. She was the perfect little hostess, taking care of everything, even making some sandwiches to her picky-eaters friends who do not eat mac and cheese (yes, it is possible apparently to say no to dinner served during a party, I am very happy my daughter would not do that, and let me clarify that it wasn't for allergies). She took care of the activities, put everyone to bed and organized breakfast this morning. She was just a-ma-zing!

I heard a conversation she was having with one of her friend and it was so cute. She was explaining to her why ears pop when you take the plane and why you should let the babies cry. Her friend replied: "wow, you just know so much stuff!" At that moment, I have to say, I was a very proud mother...

And how she managed to let her friends choose cupcakes before herself (even though it was her birthday!), how she managed who would choose first during activities to be sure there is no conflict, I was impressed.

We were having a discussion in the parking this afternoon. She said that adults are just like kids but smarter... I said: "Well, really, I think you even are smarter than some adults...(because, let's face it, some adults are not the brightest, but I didn't tell her that :-) )  It is not a question of intelligence but more a question of experience."

I really believe she is going to be a very adequate adult in some time... I am privileged to have such an amazing daughter!

Exhausted... again

Just realized that my previous post had the same title... Well, it basically described mostly the whole month really... This rotation has been mostly based on quantity and flow. Not as much teaching as I would have like. During my mid-rotation eval, my boss even said to me that we should have had more teaching, but really, with only him and us, two not so useful clerk, to round 30 patients a day, it was not possible. I've learn a great deal anyway and I have to say that my day passes by in the blink of an eye. Starting third week of this, I even enjoy it. Not that I would do that for the rest of my life... Too much cancer, too much lifestyle-related condition (that could be said for any specialty though!). I do not appreciate much the whole "university-hospital" environment. And really, it is not because of the pyramid everybody talks about. Everybody is quite nice and easy to work with. I feel that everything is just more complicated for nothing... Sometimes, when you need to contact another specialty, just trying to find the right person to contact in the 2-pages list of contact numbers with the reason to contact each one is a hell of a task! Not my kind of thing... I prefer smaller environment, maybe with less challenging patients but with better relationship with your co-workers, where you know the nurses on the floor, and everybody else. Here, each day, you have a different resident to call, so you can't establish relationship with anybody. All this thinking conforts me in my choice of trying family med at home...

The best thing is when I get home... I live with the best "rommates" ever, my room is lovely and they have the best yard in the city. I have proclamed it the best study spot ever...

And I brought back my cat/(de-)motivator/furry son with me after the first week. So, he is here trying to learn to live with 3 other cats and a big dog... Not easy learning but he is coming about and I believe he might even like his new friends by the time we leave in two weeks. And, just to have him sleeping with me eases my feeling of missing my family... In total, we're going to have been away for a whole 9 weeks. But, for now, 11 more days and we're back together...

Exhausted

I started my new rotation this morning, at the main campus... It was a lot of new things for me. New home, new hospital, new specialty, new EDC system, new everything... At the end of the day, I haven't seen any patient and I was drained... Brain dead, really.

But then, I came home, had dinner (well, the egg sandwich I had prepared for lunch) with my two fantastic landlords/roommate, and I felt a little better. I am very happy to report that I also took a 3 km fast-walk, so my family doctor is going to be satisfied (I know, I should do it for me, but I really see no point in doing any physical activity, so she is my motivation...)

And, hopefully, tomorrow is going to be a little easier, the day after a little bit more and by the end of next week, I'll be more confortable. There is light at the end of the tunnel (like there always is, let not forget it!)

Blues

Tonight, I feel blue... In less than 48 hours, I have to leave my home for a month of respirology at the main campus. I really enjoyed this month in psychiatry, which was kind of a surprise. The first week has been like an adjustment disorder, because the patients are very different. In the end, I enjoyed it much more than I thought I would... To be clear, not that I would do that of my whole life, because it is very draining emotionally. Since these patients represent at least 20% of family practice, I believe I can deal with that...

One of the big thing about leaving is I don't want to leave the only member of my family that is still here, my de-motivator in chief...

Oh, he's not going to be in a bad situation. He is going to live for a month with a very good friend of mine who loves cat. He will be spoiled as much as he deserves. But still, he is the only family I had in the last month, and leaving him behind is very difficult.

I begin to feel my husband and Princess's absence. I miss them as much as it is possible. I've never been separated from them for that long before and it is taking a toll on my mood. At this point, I don't think they will be back home before mid-June. Even though I really like this rotation, it seems never-ending, not because I don't have the motivation, but because I miss them too much.

On top of it, I need to prepare the house and the cottage for this month absence. It's nothing major, but when you feel depressed, everything look like a big mountain... (ok, you see, I have a very small tendency to exaggerate things... I don't feel that bad, just a little less smily than usual... I suppose this is my histrionic side :-) )

This weekend, I'll see my best friends in Montreal, I'll eat kabab (Yesssss!) and I'm going to the wedding of a very good friend, wearing a brand new dress. Not so bad after all!

Mother's day

Last February, I spent my birthday (a Sunday) in the hospital working. It was my decision, I thought that I should experience every part of being a family physician, and this includes hospitalization.

Today, I spent Mother's day doing psychiatric emergency, until 19:15... I haven't choosen to be on call today, and really, I didn't even realized it was Mother's day until this Friday. Being the only mom in my cohort, I could have ask anyone to change call schedule with me... I didn't. Really, what is the point of being home with nothing to do when your family is over 5000 km away? (Well, you understand that nothing to do is not exactly true... There is always some studying to do - in psychiatry, it means memorizing diagnostic criteria). I am very satisfied of my day because I learn a great deal, questioned a few patients and can you see what was the weather outside today? That white sh*** (yes, when it falls in May, it is no longer snow!) has fallen upon us this afternoon... May I remind you, we are May 8th! So better to be inside with something to do, instead of thinking of this terrible weather!

Abandoned

I am a poor woman abandoned by her family for the last ten days...

As you know, I am not poor, and certainly not abandoned...They are just gone at the other side of this huge country of ours, for a fantastic adventure. My husband had a contract for four to eight weeks in British Columbia (BC). Last time he went there, he said he wanted to bring Princess next time. So instead of trying to be the shortest time possible there, he negociates to stay longer, which means a longer exposition for Princess. Who, by the way, is doing amazingly well. 

It was quite an organisation, mostly done by my incredible husband, to register Princess in a new school and manage the school at home, dance class and piano class, in a few days. Officially, he bought the plane tickets on Thursday evening and left Saturday early morning. 

So, when he got to the new school, they couldn't put her in the same degree. We suggest registering her in the class under since anyway, she had a lot to take in... The director decided that she would be better in the upper class. She is now in a class upper than her class here, and she loves it! She has no problem in science and math (they are really not at the same level than home, she is even more advance in math than they are... Programs are different each province!) She struggles in English, but is going to learn so much! I feel she realizes how privilege she is having such an adventure with her father. And, during weekend, they have time to explore and enjoy outdoor with the majestic Rocky Mountains. Given our terrible, terrrible, terrible weather this year (an inch of snow this morning, really!), she particularly appreciates the nicer weather there.

I miss my family soooo much! But, seeing how they are doing so well, I am very happy I let them have this great time together (and anyway, I will soon leave to the main campus, 4 hours away). 

And, I should use this time for "ME" time... ha ha ha! (My family physician just berate me on exercice today... I now have time to do it, no excuses!)

Pain

Last month was all about chronic pain. Musculo-skeletal (do you know about trigger points? I learn that I have some myself!), fibromyalgia, neuropatic pain and CRPS (complex regional pain syndrome, very interesting!), and a lot of psychiatric pain.  And it was amazingly interesting.

To start with the beginning, pain always comes from the brain. Pain is an interpretation or a translation of a signal, which can -or not - lead to pain. The brain decides if it should be painful (like when you burn yourself with a bath too hot) or if it is insignificant and just delete the signal (the sensation of your clothes on your skin). The brain can also produce some pain without even a significant signal from the system... The brain being this incredible piece of very complex machinery could very easily malfunction.

My attending explains pain to patient with the perfect analogy. Your body is like the alarm system you have at home. You have some nociceptors (pain receptors), which are like the windows and doors detectors. They can be activated if there is a thief  trying to get in, or they can malfunction (false alarm). When the detectors are activated -in nociceptive pain like pain from a broken bone or osteoarthritis- the alarm central (which is your brain) can decide if it is real and send the police (pain) or decide that it is probably a false alrm and dismiss it. The communication lines (the nerves) between your detectors and the central can also be damaged - in neuropathic pain like diabetic neuropathy, or when your nerves are damaged by diabetes. When it is the case, your central does not know if the signal is real or not and might send the police to investigate. Finally, your central can decide that there is a lot of thieves around the neighborhood and will send the police even if there isn't real significant signal - in central sensitization pain. Thieves can be any signal being identified as damaging to the brain, including important emotional events.

Chronic pain is therefore a very diversified practice. I visited two clinics in two different cities and the patients in both clinics were not similar. While in one clinic, we saw more women and psychiatric conditions, in the other clinic, it was more about men with back pain trying to get disability (which the attending was not giving easily. It is well supported in litterature that if the patient stop working, it will be very difficult to get him back to work. So, manage pain with different modalities, but keep them working.)

What I love about chronic pain management is the interdisciplinary approach. During my time there, I has been interacting with a nurse, a physical therapist, a psychologist and a social worker. I really want my future practice to include some interdisciplinary work. I don't know if it is going to be in a chronic pain clinic, but I would be interested in such a position if available at that time... We'll see...

Next month, public health!

Falling in love...

Last Friday was the end... of the best rotation ever, I am sure of it. It was just perfect!

I loved every minutes of it, every patient and everything. I love my first week in the hospital, taking care of patients in that setting, even if it meant working during weekend, even during my birthday. I learned a lot. Really, I have to say that, I felt at home, exactly where I should be. I had fun with the colleagues, I cared about the patients and I feel the patients really liked me. I was sad when my week ended, because I was loving it so much...

But then, I went to the clinic and it was just perfect too! I felt right at home there too. I really appreciate the feeling of being responsible for the whole situation (not that I was, per se, but that we are addressing all the issues). I did a happy mix of follow-ups, new consults and emergency clinic, with 4 differents physicians. It was very interesting to see how each physician choose different patients. Dr. X's patients are more anxious type, while Dr. Y's are multi-morbid and much more sicker... Dr. Z has a very close relationship with her patients and I had to work harder to win them and establish a physician-patient relationship, but I did and she was impressed! Few patients told me I will be a good doctor, and I have to say that is our paycheck right there. And I even diagnosed an atrial fibrillation in a patient that was there for something else completely... I might have save is life (or not :-) ), and Dr. Y said that if I hadn't find it, he would't have. Very gratifying.

The only negative point about it... it was too short!

And now, anesthesiology and chronic pain for the next four weeks... It is going too fast and switching hospital and boss and specialty every 4 weeks is hard...Once you start feeling a little bit competent, and feel you can make this diagnosis, then everything change and you become incompetent again...

In between...

This weekend, I am in between two rotations. I finished endocrinology on Friday and starting Family Medicine with my favorite mentor ever on Monday... This looks like it will be a great month!

My first rotation ever was great. I was a little anxious doing a speciality as my first time in the hospital, but I have to say, it was just perfect! My supervisor is a very good teacher and he made it easy for us. I learned a lot, about endocrino, but most of all, about myself and the type of practice I would like later. And, to my surprise, I completely fell in love with the diabetes, the patients, the treatments and everything that goes with it.

My most important learning of this month is about taking charge. I want to take the patient as a whole and not just part of him. I saw a patient for a reason, which was not abnormal in the end, but had another medical issue that would not be handle by endocrinologist. We referred her back to her family physician. It felt unsatisfying, leaving the poor soul like that when it was not a huge problem to fix. (and let just say that we followed up by a phone call directly to the said physician just to make sure she would be seen very soon, so not just letting her wanders on her own). And I completely understand why the specialists do that, because 1- it would be totally unmanageable if they would address every problem of every patient and 2-they cannot be confortable dealing with every health issue because, well they are specialists and they don't (and cannot) follow guidelines and new treatment for every disease there is.

So, I suppose this confirms that I would like family medicine. I still consider general internal medicine, where you can take charge of patients as a whole, but having sicker and more complex patients than family physician (usually). I think I would like that very much. Still, food for thought for the next few months...

And, as of tomorrow, family med hospitalization for a week. I am thrilled! Hope it will meet up my expectations!

The best moment to be happy in life...

This week, I've heard on the radio of a study by University of Alberta about mid-life crisis. (http://www.cbc.ca/news/canada/edmonton/mid-life-crisis-a-myth-university-of-alberta-study-concludes-1.3399494)

I completely agree with the results. I feel that I enjoy life (and my journey in med school) much more in my 40's than I would have had in my 20's. I was an anxious little thing back then, and I now have more self-confidence, a quality that can be very useful during clerkship. I enjoy myself tremendously right now and I had good comments this week that make me think I am not doing too bad. (One patient told me that if I become a Family Physician, she wants to be my patient, what a compliment for a first rotation! That is my salary for this week!)

As of tomorrow, I will have gone through half of my first elective. I am currently in endocrinology and I have to say, I really like this. I spent the whole week seeing diabetes patients, but I also saw, osteoporosis, thyroid problems and even a patient with acromegaly. I also love the quality of life I have right now. I feel that clerkship is much more easy to manage than was studying.  I have more personal time. I discussed it with a collegue doing another specialty and she feels the same (so I am not crazy, or not doing what I should do).  And the motivation of seeing patients everyday, and learning so much! Wow! Also, I feel I have a much more normal life, being in the hospital all day, and then coming home and not studying until midnight every night.

My husband is gone for work this week and, even tough I am eager to see him this weekend, I feel it is easier to manage being a single mom than while in school. I feel the worst is behind. I will certainly have rotation much more difficult than this one (ObGyn, two months in a row?), but still a month is so short!