The ice never bothered me anyway

I don't actually mind winter. I enjoy snow. I like skiing. I'm terrible at skiing. I like to cook warm stews and cozy up in a ski chalet. But the first moment I slip on a patch of ice I think about moving down to Florida and becoming a snow bird (birds are a lot smarter than us).

The snow can pile to my waist if it likes, as long as it stays wonderfully fluffy and white. When it gets compressed or icy rain comes and the roads turn slick, I HATE it. My new boots have literal spikes on the bottom to keep me from slipping in every direction and I still can't get to the trunk of my car from my driveway. There's a giant, thick layer of ice right behind where I park.

Upon returning from two weeks away at the FMF conference and teaching week, I found my stairs buried in about 2 feet of snow. I was wearing flats and stockings with cats on them. Good thing I had a pair of boots (city boots, for show more than snow) and some gloves (again, impractical but pretty leather gloves) in my car. I had to steal my neighbour's shovel to dig out my shovel. There's still enough snow on the deck I'm worried it's going to collapse. My solution was to run away since I'm now back in GFW for pediatrics. I dread what awaits me upon return.

On an unrelated note, while in Toronto for the conference, I went out to JBBQ with friends. We built a meat wall. My (very thin) friend managed to eat pretty much a full cow equivalent on her own.

Overprepared

There's hardly such a thing as over prepared in medicine. You can always double or triple check that prednisone dose. Do one more sponge count after a delivery. Hell, why not ask to make sure the patient doesn't have chest pain today?

Other places in life, though, may be a different situation.

This beautiful Thanksgiving weekend I went to Gros Morne National Park (!!!) with a few coresidents. We went in two groups: the competent hikers and the less-than-competent. Guess which group I was in. The others did Gros Morne Mountain in about half the time it's predicted to take. I did a bunch of smaller trails instead.

Not that I minded. Green Gardens was the place of fantasy. Lookout hill permitted a spectacular view of the Tablelands. Although Lookout was so muddy from maintenance construction that I sank about knee deep in bog/mud more times than can be counted. There were so many shoe-stealing bogs that I almost face planted half a dozen times. Came out with mud stains to my knees and soaked feet despite heavy duty hiking shoes. I have new sympathy for the soldiers at Passchendale.

I'm already dreaming of my next trip back to Gros Morne. A summertime visit, staying in Rocky Habour or Norris Point. Nothing but hiking, boat tours, and picnics in scenic ocean fronts.

For this particular visit though, I may have over prepared on food. I also made a detailed Google map with every hiking point, scenic area, information center and gas station, but that's beside the point. That's just my normal trip preparation. I also may have packed three pairs of pants for about 8 hours of hiking, but also my normal level of prep. I didn't even bring a nice dress and heels to change in case of dinner, thanks so much.

In the case of food, for only two, maybe up to four of us hiking (and other people all bringing their own food!), I brought 4 boxes of granola bars, 2 bags of chips, 1 box of cooked chicken strips, 1 package of cold cuts (proscuitto >> ham), 1 bag of pears, 1 box of cut fruits, 1 box of cut vegetables, 1 box of cherry tomatoes, two kits of tuna salad/crackers, 3 sandwiches, pallet of water, energy drinks, 2 bags of dried fruits and various other smaller snacks. For 2 people. Maybe a little much.

We did NOT end up needing to eat it all, as it transpired, despite walking so much my legs are still sore today. So now my fridge is full.

I think the need to over prep for trips come from some unfortunate mishaps in my younger years while travelling with parents. In no particular order they've forgotten to pack cold weather clothing, started a 3 hour drive (not including Toronto traffic) for a day trip at about 2PM, didn't know there's more to a national park than the visitor's center, forgotten to pack food other than candy for me (guess who got carsick?), thought they could book day of beachside cottages, figured to see salmon swimming upstream they just needed to drive in the general vicinity of water, and many more...

My parents no longer have any hand in planning trips out with me. I book everything. I plan everything. They show up where I tell them to, according to the destination I put in on their GPS. Works out well for everyone. Not once have we ended up without reservations for the night, or needing to find a restaurant on the fly, since I took over.

Western Brook Pond in sunset

Approaching Western Brook Pond

Trees and rocks and rocks and trees...Then, WATER

Walking on the Earth's mantle

Green Gardens

Green Gardens/Ireland

Autumn colours

Top of lookout hill, at Tablelands

Identity Crisis

Yesterday I lost my ID badge while on call. I searched under the beds of every room I saw a patient in. Dug through the bloodied linens and discarded gowns from the deliveries I attended. Checked what I thought was every crevice of the entire obstetrical floor. Had housekeeping, security, laundry services, front desk, and the entire nursing staff plus several helpful visitors looking for it.

As it turns out I had taken it off to do a speculum exam and left the damn thing on the windowsill beside me. I'm real smart some days. Unfortunately the amazing nurses that went on the hunt for me didn't find it until this morning, after I spent the night fretting about how to replace a badge from a university 5 hours away.

Without the badge I can't access the ER. If a patient codes, I can't get in there with any rapidity. I can't access the surgical floor. If a patient goes for immediate c section, I can't get in or even get the scrubs I need to do deliveries. I don't even have access to the local gym, with the access tied to my badge. Out of shape as I am, I do enjoy the 30mins of walking and sauna time I get.

Most importantly, maybe, I realized for the first time how much I tied my self view into the two little letters in front of my name. D. R.

Two letters I spent my life until now pursuing. Dreaming the day I enter university, get accepted into medical school, become a resident and finally paid (less than minimum wage by hourly, but still) to be a physician. The MD behind my name. The Dr in front of my name.

Residency can still be more challenging for me so far. I feel like I'm not being pushed to my limits daily, which I had masochistically hoped for. That said, it's still an immersive experience that, especially in my rural settings, takes over most if not all of my life.

I used to identify part of me as a dancer. A classically trained ballroom dancer with preference for the rumba. Since leaving my long term dance partner back in Ontario, that's faded out of my life. The only vestiges of it are my daily preference for high heels.

Cooking was an invested daily activity that even my residency application letters were based on. Yet constantly on the move across the island, limited groceries and with most of my favoured cooking tools (my fondue pot cries out at night for me I'm sure) back in Ontario, I've been subsiding on a diet of microwave and half-ready meals. My waistline and wallet is paying for it, believe me.

Going out with friends, even if it meant just dumping our laptops on the couch and pretending to study while we gossiped about the controversy du jour, is non existent. Very few people anywhere that I've been placed has had people my age. People around the same place in life as me, even less.

By that above statement I mean I've delivered too many second, third, fourth babies to parents many years younger than me. There are no groups of 20somethings looking to go out and hike together, but many mommy and me groups on the social media here. My bare few coresidents and I are scattered throughout the island, often on different rotations, and can barely meet up on a monthly basis.

All this to say, when I lost my badge at about 2AM in the morning after a rough call shift, I bawled like a baby in bed. Freaked out that I am nothing without a scrap of plastic identifying me as a doctor. No other labels in life, nothing to cling onto except those letters.

That's not an emergency...

I just wrapped up my last ER shift, and it's been an interesting experience. It's certainly not HGH, where we had traumas crashing through the door at all hours of the day. I saw aortic dissections (I wouldn't wish it on my worst enemy), car crashes, full body burns on a terrifyingly regular basis. The excitement is certainly everything I imagined of an ER. People running, doctors being paged overhead (I used to fantasize about being paged. Now I do everything to avoid being paged), and paramedics run a revolving door of patients.

It's not quite like that out here. The real traumas get sent straight to St. John's, so most of what I see here are really walk in clinics. I don't mind, in a lot of ways. I find the culture a lot less malignant than city hospitals. For one thing, without there being permanent residents based here, there's no expectation that we work around the clock.

I enjoyed being on call on internal back in clerkship, I really did. But was 4AM really the necessary time for me to consult on a patient with stable afib, going for surgery 5 days later? Not even a little bit. But I did. I did so many of those it wasn't funny. I literally fell asleep during one at the computer. I also did 'consults' on ICU transfers to our ward. Why these transfers happened at 2AM instead of 2PM the day before or after? Hell if I know.

Instead we as ER manage patients overnight if they're stable enough. We don't call our internists at 430AM for a stable afib. We don't page surgery stat for a query pancreatitis that isn't septic. We give antibiotics, we start fluids, and we monitor.

What I find harder to swallow is the state of this place's family medicine being reflected in the ER. I've lost count of how many patients came in for mind boggling minor complaints because they're concerned (rightfully so, anyone would be without medical knowledge) but have no family doctor. The waitlist doesn't even exist for some doctors because of how loaded down their practices are.

Patients come in for coughs because the waitlist at their doctors is 5 weeks long for an appointment. And that's how I end up doing insurance forms, viral coughs, and aches and rashes all day and night long. It's also one thing for patients to come in at 3PM and say they have a rash. I get annoyed when they show up at 3AM.

From their perspective I can see why they show up at 3AM. The ER is almost guaranteed to be empty. At least in the waiting room. We usually have a full house of overnight patients that I'm watching all night. From my perspective I'm just annoyed. I've been on all day, I'm exhausted, and in no medical logic is it appropriate to see an arm pain that someone's had for 4 months, unchanged, at that hour in the ER. It's not appropriate to be seen in the ER period. Especially not one that's been cleared by their family doctor and medically maximized in terms of management.

For those patients: please stay at home. I really won't be able to do anymore than what your family doctor has done. No I cannot send a specialist referral at 2AM in the morning. I can barely send them at all and you won't get in any faster than if I sent it versus your family doctor. Do yourself a favour and don't get out of bed at 1AM and drive in the moose infested dark roads. Stay home and see your family doc.

The med student underground tunnel

Among the most prolific rumor mills is the under-breath whispering of all medical students and residents: past, present, and future. Not only does details of interesting cases get passed around, but the real nuggets of information are the details on rotation sites and preceptors.

Which sites have the best call rooms? Which call rooms have windows and a better wifi signal? Which parking lot was designed to scratch up your car?

The real important question is: which preceptor do you avoid?

No stranger to these questions, I've contributed a few myself. I've advised classmates on my favourite rural rotations, best sites to get hands on suturing, and, of course, which staff physicians were the bane of my existence.

Over lattes and cocktails alike, we've swapped stories of being pimped out (interrogated on our medical knowledge) in front of patients by certain doctors. I shared the story of the surgeon who made me cry on my first day of clerkship ever. That one resident who used us for nothing but scut work (non medical work like buying coffee and photocopying lists). The doctors who are hard to reach on page.

The value of these wisdom-s can't be underestimated, but sometimes they're over exaggerated. There is one site of rotation for pediatrics that all former students rage against. They called it a waste of time, extreme hours, lots of psychiatric issues and in a boring town. I got sent there with only dread knotting my stomach. What I found was a charmingly small town with great school provided housing. An amazing preceptor with whom I still keep in touch and extremely immersive work in a rigorous but educational environment.

I have just recently again been warned against one of my upcoming preceptors. They won't be my main staff, but I will have to spend at least some days with them. 

I'm hoping this will be a case of over exaggeration, but like all things in the rumor mill, one can only go through it to find out.

Goals of care

I'm now on ER service. The first two shifts were brutal. 14 hour night shifts. I'm used to 12hr max ER shifts, which is what residents are supposedly allowed to do maximum of. But it's not like I can take off at 6AM when my staff is there until 8. I get paid a whooping 40$ per extra hour I work. Whoo... I'd pay that much for a place to sleep.

As a med student, the promise land where residents get paid seemed so glorious. Now that I'm actually here, turns out we barely scrape minimum wage, especially compared to Ontario. Hah. My on call hours is definitely sub minimum wage. We're also 2 weeks behind our pay schedule so I'm still relying on my line of credit to stay fed...

Today I had a patient who changed their goals of care on me several times. It wouldn't normally be a huge issue but this was an unstable patient that was deteriorating rapidly. More than most, the people in front lines healthcare understand that having an advanced directive, as it's so delicately put, is of immense importance. How much do you want over eager/terrified med students, hefty paramedics and strung out night call teams to be pounding on your chest and smashing rib cages when you're 50? 70? 90? When you're healthy versus when you have diabetes, previous heart attacks, and failing kidneys?

It's a painful talk but it's being honest with yourself. Will you have a good outcome? Is the outcome probabilities in your favour enough, that you want to chance it? How good is your health, really, and are you the kind that wants to hold out for any miracles, or prefer to go on your own terms?

Also, I'm starting to notice that ER patients come in waves. Yesterday and today we had two separate waves of almost identical patient populations, all with similar symptoms, all presenting around the same time.

On a more pleasant note, Newfoundland still boggles my mind. It is breath stealing beautiful. Every corner you turn there's a moment of 'holy crap how can something like this exist and why has it taken me so many years to find it'.

A few days ago my coresidents and a few dentists drove down to Salvage. WOW. There was a moment as we pulled out of Terra Nova to cross into Eastport. One of those golden, framed moments of glorious summer and youth. On the bridge over water, the ocean before us, the cliffs behind us. Windows down, sun bright and just a couple of 20 somethings, all finally escaping the drear of the hospital.

The post call slump

Per every overnight call we receive what is a post call day. Typically this day is used for sleeping, although often times we forgo that privilege in order to get necessary adulting done. Get the oil changed (which I still haven't done, thanks so much), renew licenses, drop off paperwork and other such fun business.

On home call as I have here, I don't have a post call day unless I go after 2AM. I've gone until 1AM so far, with no post call day the day after. I don't mind too much, since I often don't sleep until very late anyways, but it's hard to adjust to life without a guaranteed business day off every 4 days or so. I'm finding my paperwork a never ending pile. As soon as I get one thing done, three more comes in. Someone else needs an extra confirmation, this file is missing a signature.

I've been on 1 in 2 call a few times during surgery, mostly due to the surgeons' changing their schedules to accommodate vacations. I have no vacations, so I just do call with them. This has resulted in a perpetual post call exhaustion. On normal post call days I've been able to get some brunch then crash into bed for a few hours. Without these days I'm dragging my feet and barely awake at all hours of the day. Especially when an 11th hour appendicitis comes in, I'm 3/4 useless. I'm amazed at how the surgeons are still running, although they're getting notably grumpier with each progressive call in a row.

It's been some beautiful weekends but I've been hiding at home. Partially because I'm too lazy to put on the sun screen to keep myself from burning, partially because I have no one to go out with. One of my co residents is here with family, so he has company. My other co resident is from here and has a boyfriend, so she is also preoccupied. I can barely bring myself to hike the trails I know well back home, let alone take on a new cliff-and-coastal trail by myself here. Have I mentioned I have no signal 90% of the time? Rogers, amiright?

Beep beep beep beep

I don't get paged much too often during this rotation, certainly not on the scale of my internal medicine back in clerkship (over a year ago, although the memories are fresh - excepting anything useful). The sound of a pager will always make me jump. I think if a med student/resident was in a coma, the one sound that would wake them up is the almighty annoying pager's terrifyingly high pitched beeeeep beeeep beeeeep. The one sound that haunts all our dreams, and often wakes us up from dreams.

I remember my first night holding the team pager, I broke into a cold sweat every time it went off. This is with a resident who backed me for every patient since I couldn't give orders. I also remember sitting up in the middle of sleep on internal medicine. Poor captain was just playing around on his phone in bed. Apparently I sat up, turned to him and very angrily demanded the team pager. And then I asked him 'Dopamine? Why not L-dopa?" Note that I literally have never prescribed either of those medications, and can't do neurology to save my - or anyone elses' - life.  Then I wanted him to report on a patient he rounded on. I was asleep through this entire exchange.

Another memorable page was towards the end of our internal rotation (do you see a pattern here?), when it was my best friend's birthday. One of our mutual friends snuck a cake into our on call lounge. Literally the second she leaned down to blow the candle we got a level 1 alert page. I.E. Run for someone's life. We left the candle burning and our friend sitting while we ran. Yes she got to blow out the candle 2 hours later when we lit it again.

My scariest yet most adrenaline pounding page was, again, internal medicine. At about 4AM (I remember staring at the clock in disbelief), doing my 5th consult of the night, working non stop since 8AM that morning, and consulting the most boring patient. Boring patient is good patient. They're standard, easy to treat, but hard to stay awake for. Just a presurgical consult for someone with a minor problem. Why this couldn't wait until the morning (still many days before her OR) I can't figure out. A whole room of residents and med students, all walking zombies. Then, breaking the silence of keyboards and pens scratching papers, the ear splitting shrill of 5 pagers all going off at once.

Only one thing triggers all our pagers at once (except an alarm test), and followed by immediate overhead alarms blaring: CODE BLUE. CODE BLUE. WING X. REPEAT. CODE BLUE.

A patient has crashed. Heart stopped. A split second where we all turn from our screens to stare at each other, then chairs being knocked over and flying as we all rush out the room at once. In front of us security is directing the way, nurses waving their arms like plane runway attendants flagging us down hallways.

You forget how out of shape you are, that you haven't eaten since 2PM lunch that day, that you haven't slept in who knows how many hours. It's a dead run and the moment you tumble into the room, jump on the patient's chest and start CPR. Only when you're switched out from compressions do you realize how out of breath you are.

That patient in particular didn't make it, but a lot of patients don't when they code. That was one patient who would have never survived a code either way, due to age and comorbid diseases.

Every time the pager rings, or anything that sounds remotely like it, I have an automatic reaction to slap my chest and hips at the same time - where I normally carry my pager. I look like a maniac wildly groping and slapping myself in public unfortunately. I've seen a few people give me sympathetic glances. I assume they're also losing sleep to pages.

(Sort of) a week in

It's cheating, technically. I was only on for 4 days, and one of those days I only did half to get my license and everything fixed up. Speaking of, the plates are still in my car, I haven't been able to muster the dignity to go out where neighbours can see me and let everyone see my ineptitude with a screwdriver.

I'm not on call this weekend but for how not productive I'm being I may as well be. It's 3:30 in the afternoon, all I've done is sleep in, do some laundry and dishes. I haven't cleaned out the food I didn't finish eating from last week yet.

There's a chicken maple dijon recipe that I've tried 3 times and still can't get right. Everyone else hails it as the best chicken they ever had. I haven't once managed to eat more than one piece of it before letting it go bad. I swear I follow the recipe exactly, and it's from a chef that I trust. I have no idea what's happening. I like maple (I'm Canadian!) and dijon. I love chicken. Yet dijon + maple + chicken = blearghghfhf.

Ah well. The cheeseburger casserole turned out better than expected, and I'm trying to decide if it's too soon to cook it again.

I've been trying to get to the gym for 4 days now (day 4 today) and haven't succeeded yet. I've set a trap for myself. I only take out the (very meat and vegetable remains filled) garbage if I go to the gym on the way. I figure the smell will drive me out eventually.

The days are long but the nights are longer

It's my first call as a resident. I've always been told that as a junior resident you have backup. You won't be on your own because everyone knows you're basically useless. Yet I have no senior here because this small program doesn't have seniors on off service with you. There are no specialist residents here.

Given how unprepared I am to take on call, I'm surprisingly disappointed by how little everyone is calling on me. Despite me going around to ER, swithboard and the wards today telling everyone that I'm the resident on call, to call me instead of staff, no one has seemed inclined. Instead I got called in for a consult by my staff, and I'm otherwise sitting around and kicking my feet.

What I should be doing is sleeping, since this is home call and I have to go to work tomorrow.

While rushing into the hospital earlier for consult, I went into ER in a white lace dress to see the patient first, then got changed into scrubs in case it turned surgical. As I was going into the ER again, someone behind me muttered 'I told you she's a doctor'. I guess white lace doesn't scream doctor on call.

Small towns and being satisfied

For my family medicine core I was placed in one of Mac's most rural locations: Rockwood. It's a little town about 25mins out from Guelph, which most people in the GTA consider to already be a small town.

I had an amazing rotation, with kind preceptors, great staff at the clinic, and interesting patients. My favourite part of the day, by far, was coming in 30 mins early to sit down, make a cup of coffee/tea, and look through my patient list for the day. I could go through their history, make some notes for myself, and read on the chief complaint the receptionist took down. I got to do some hands on things like remove moles, punch biopsies, cauterizing, and home visits. But it didn't feel like enough. Rockwood wasn't rural enough for me. Not enough hands on, and it sounds unbelievably selfish and spoiled, but too many resources.

In the same way that surgeons crave hands on, trauma, big open surgeries, I craved the wild west of family medicine. One where I didn't have a radiologist on my speed dial (yes we called the poor man on a near regular basis). Where there aren't 7 allergists at my beck and call to send someone with the mildest rash after eating a very hippy hemp granola whatever bar. The surgeons know that minimally invasive surgery with cameras and keyholes are better for patient outcomes. I know that patients in well supplied resource centers have higher quality of health. But I can't help but feel like if there are still spots where a dermatologist wait list is a year long, shouldn't I be there instead?

On an elective in family medicine, I went to northern Ontario's Petawawa. It's a Canadian forces base, and the town that built around it to service it. I didn't tend to the active military, but all the retired, the families, and the local population. It was - and still is - one of my favourite experiences on record. I got to do ER shifts, home visits, geriatric clinics. But I still missed how much hands on experience some rural physicians are able to get. Although I was a mere first year clerk at the time, and I doubt my staff trusted me to remove an SCC from someone's face.

Despite the wonderful amenities of semi rural areas like Rockwood, it wasn't enough. I don't even know what satisfies me in a practice at this point, and I'm afraid what I'm looking for might not exist. At the very least it won't coexist with my love for good and varied food in a place.

On particularly Canada Day, I'm missing home desperately. There are no fireworks in town tonight. Meanwhile Toronto has a list of top 10 places to see fireworks. I miss going to the ballet because a show or company I like is in town. I miss casually meeting friends for Spanish paella, Mexican tequilas and soft tacos, Korean hotpot, or Chicago style pizza. I definitely miss being able to call an Uber or skipthedishes, and have sushi delivered to my lap.

I thought I could trade all the amenities for small town life, but it turns out the small towns I've experienced until now are remarkably urban compared to my current location. This is more than small town, it's full blown remote, but still remains one of the biggest cities in the province.

Time will tell just how much I'm willing to change my lifestyle for the practice I want, I guess, and if that practice even exists. Two more days until I start doctoring.

Adapting to less pleasant things

I'm back inland of the island now, and the weather is significantly nicer. It's a warm and breezy 20 something Saturday, except I'm sitting in bed and kicking my feet. Rarely do I sit around on such a nice day, but there are no good hiking trails in this neck of woods, only one little park that is swamped with children and their families on such a day. That and I have no one to go with, which sucks a little.

Yesterday I went grocery shopping properly for the first time and almost broke down in the store. I've never seen such a poorly stocked store. It looked like a hurricane went through, only there was minimal selection to begin with. No such thing as the summer fruits that I've associated with this time of year. No fresh strawberries, no local cherries, no plums or peaches or nectarines. No pineapples, no watermelons, and certainly none of the more exotic features I had at home: dragon fruit, star fruit, guava, etc.

The vegetables all looked like they were picked 6 months ago and shipped on a slow boat over (which let's be fair, they probably were). I've seen more vegetables in winter in communist China, and that's not an exaggeration. Spinach? Hello? Lettuce more brown than green.

On the other hand I'm starting to see how it would be hard to maintain a sustainable, healthy diet here. $6 for a head of cauliflower? Are you kidding me? Apparently I'm paying for the airfare from California for that cauliflower. At some point it's probably cheaper to fly to Halifax, pack a suitcase of vegetables, and fly back.

I was expecting to lose some of my comfort luxury-ish foods, like freshly imported Italian cured meats, pate from France, and more spices than I can shake a salt shaker at. I wasn't expecting to not find tomatoes, or bananas, or potatoes, or brown rice (there's an entire selection of instant rice though).

It hurts me a little. Food is my one, favourite comfort. I cook a pot of bucatini alla amatriciana after a hard day on the wards. I make coq au vin when I have guests over. Fashion and shopping is my other comfort, but there isn't a single viable store in the whole town. The nearest Loft is off the island. The closest, proper mall is in St. John's. While I've been known to travel distances for clothes, 4 hours of driving is pushing it.

It sucks. It sucks losing both of my top go to comforts in one of the most stressful and lonely times of my life so far. It sucks not having friends nearby. It sucks that my boyfriend isn't here. It sucks that everyone else on my social media is settling nicely into their new homes of Kingston, Toronto, London and Hamilton, and I'm still trying to figure out how to not get scurvy from the food here.

The one thing I'm repeating is that I chose this. I didn't come here for the lifestyle. I definitely didn't come for the food. I came for the training, and that's what I'll do in 3 days. A couple people have also proposed I treat this like a cooking show challenge: figure out a diet for locals to survive on that is affordable yet healthy. So far my plan involves annexing Florida in the name of Newfoundland.

This weather...

It's a typical Canadian thing to meet up and complain about the weather. I swear I will never complain about the weather in Ontario again. In the same vein that I looked down on southern residents of the US freaking out over a few centimeters of snow, I now can't say I was ever cold in Ontario.

It's snowing. It's June 26th. We're days from Canada Day. IT IS FRIGGING SNOWING HERE IN NEWFOUNDLAND. SEND HELP.

I feel like it's time to start planning life as a snow bird. Fly back to Ontario for winters. I assume they'll seem much more mild, considering even summer is winter around these parts.

That's all. Just needed to let someone else know about this nutjob weather.

Certification is not competency

I can't tell you how many times that has been repeated to me. I'm most of the way through my orientation weeks of mind numbing amounts of paperwork, training modules, managing labor and delivery emergencies and resuscitating babies. I kind of got that doing a pretest of a couple multiple choice and one day of blitzing through CPR on babies isn't really going to make me a neonatal intensivist, yet regularly the staff are reminding us that at a rural site, it might be just us. Just me as the primary physician?! Maybe don't come into hospital for a few more years. I still can't believe there may come the day when I'm the most senior person on.

On another note, today the captain left back for Ontario. I'm devastated in some ways, but relieved in others. This feels like a finale and a fresh start, rather than the tentative past few days of we-know-it's-ending-but-it-hasn't-sunk-in. I've planned to do a little St. John's trapezing on my own, especially The Rooms. I hate exploring museums with other people, it's rather like someone reading over your shoulder. I also intend to get some personal time with the botiques downtown.

But I miss him. I'm missing him desperately and not knowing when I'll next see him. In nearly 6 years of being together we've never been more than a month apart. We've been lucky that way, I guess.

2 days to go - for me

I went to my new gym today. I'm still very intimidated by gyms despite multiple assurances from everyone that go more than me that no one is judging. Except I'm totally judging. I'm a bad person, I know. Mostly I judge me, if that helps. I couldn't bring myself to step into the weight room so I hid in the safety of cardio machines and failed at using a stationary bike. (Why are they so high off the ground? Why is nothing easy to adjust? Why does my crotch like to fall on the bars?)

But I'm starting to get out of the apartment at least, and alone for the first time. Trial run as I'll be dropping off my boyfriend of almost 6 years (nicknamed the captain) a short week from now. Then I'll be truly alone. I've been a bit weepy about it.

What I try to remember is that I'm doing this for me. Most decisions in my life I've made on the basis of family and other relationships. Convenience's sake. Comfort. This time it's for me. I stayed close to home for undergrad for financial and family reasons. My parents wanted me close by. I stayed close for medical school despite the chance to go west for family and boyfriend and friends. This time I'm going where I want and without so much as a by your leave from anyone else. This decision I made for only what I want.

Yes, faith, it is my cousin’s duty to make curtsy and say,

“Father, as it please you.” 

But yet for all that, cousin, let him be a handsome fellow, or else make another curtsy and

say, “Father, as it please me."

- Much Ado About Nothing

3 days till it begins - moving in

I've officially made landing in St. John's after a long journey across Canada. It feels like the first time in a long journey that I'm finally waking up and going to sleep in the same place, and in my own bed. Well, own is relative here.

I had ordered furniture from IKEA but they canceled my order without explanation, blaming my bank. I called my bank who said they did no such thing. Best I can figure IKEA decided they didn't want to ship to Newfoundland so just cancelled my order. Another classmate has his delayed until who knows when, and he's coming with a baby in tow. I sent out a call for help on the local Facebook group. Credits to that Newfoundland hospitality (southerners got nothing on us): everyone responded by recommending a million places to go, things they were selling, stuff they wanted to give to me for free. Everyone wanted to help move me in, no one wanted to be paid for it in money or craft beers (stopped at Quidi Vidi brewery for iceburg made beers).

Thanks to everyone's kindness, I now have a bed (although the frame cracked after the first day, so now I'm on box springs and falling out of bed), couches, coffee table (!!), and dining set. I never realized it was a luxury to eat and sit at the same time. Not too bad an introduction to my home for the next few months.

While here we dropped by my future home: a lonesome but beautiful tourist/fishing village up in northern Newfoundland. Despite the freezing location, it sells itself as the mildest winters in Canada...hm. I'll report back. So far a group of seals greeted me there by flipping around and sticking their heads at me. No moose welcoming party yet. Good. I'm still scared of them for mostly inane reasons.

Today I dropped my parents off at the airport. It's starting to feel real now. This feels like my own moving-out-for-college thing. I stayed at home during undergrad, and stayed close by for medical school. I never did the big move thing, even though I only visited home maybe once a month. Suddenly I feel like I'm on my way, even though the boyfriend is still here for a week or so.

Paperwork is still piling. I have not made a dent. I guess it's time to actually get to work now.

Day 5 - paperwork mounts

Currently in Moncton and I have to say, I'm having some regrets about not ranking New Brunswick higher for training sites. So far every part of the province I've been to is lovely. Fredericton was charming. Grand falls was delightfully peaceful (except some neighbours that decided 3AM is a fabulous time to work on their cars). Moncton is convenient yet with gorgeous views. Bay of Fundy deserves every instagram it gets. I suppose I'd actually have to pick up French again if I moved here.

A few days ago we were in a small town on the outskirts of Quebec, where they didn't speak English at all. I ended up falling on some highly questionable high school French (sorry Mme Flynn!). I think I ordered some sort of sandwich for my mom. The food was tasty, and Quebecois poutine definitely trumps Ontario's best imitators.

I've got another day and a half or so left here in New Brunswick and I'm starting to sweat from the lack of paperwork I've done. My CPSNL application remains unsubmitted, though I intend to do that tomorrow. My ALARM pretest is currently open on my other tab and I'm pretending that I know how to count FHR. I've generally had an ultrasound machine for that.

Tomorrow is the time for worrying, for now it's time to remember how to do basic math again (40 heart beats in 8 seconds, how many per minute...ai).

Day 3 - fears and cracks are opening

I'm now officially enroute to destination: Newfoundland. Today is day 3 of the journey. Currently in a car from Montreal to Grand Falls New Brunswick.

On the 22nd I came back from Italy and proceeded to sleep for 2 days. On the 23rd I had a wonderful day with one of my oldest friends. Ramen and shaved ice and all the Asian snacks I'll miss on the coast. On the 24th I casually passed a large milestone: graduation. I was so jet lagged I forgot to wash and style my hair. Of course the first thing my mom said upon seeing me: what the hell happened to your hair.

It was still a wonderful day. In the morning I greeted all the classmates that have gone through medical school with me. We walked across the stage to our parents' delight, our assistant Dean butchered a few names during commencement, and we finally took our Hippocratic oath. A moment of chills when I recognized that I was finally standing before family and in the company of some of the brightest and best people of my life. And we were swearing the ancient oath (or at least modern translation) that promises to be good physicians. In the afternoon we went through the arduous affair of actually graduating and receiving our diplomas. I grabbed my diploma and ran.

On the 25th I packed like a maniac for all the time I skipped packing earlier and left a trail of scrap papers, lone socks, and dust in my apartment.

First thing 26th I set out to Montreal.

Almost there, and only a couple provinces and a mountain of paperwork between residency and I.

T- 21 days - the end and the beginning

Today I wrote my MCCQE1. It definitely wasn't the most fun time of my life. For security and professional purposes I can't say much about the exam. I'll just say that I tend to mouth questions as I go, and since we weren't allowed water at our stations, I was bone dry by the end of it. I also alternated wildly between sweating from anxiety and freezing from the room.

In some form of pathetic fallacy, the wind raged here today. Although I guess soon I'll get a taste of what real wind is like on the norther NFLD coast. Everything went everywhere and my scarf became the crazy arm waving inflatable things. It also tried to strangle me. On a different note, I regret wearing a dress today.

I'm sad. Sad and happy.

This is the end of medical school for me. 3 of the most amazing, wild years of my life. I'll never be a medical student again. Yikes. Now I'm responsible for people. I reminisce on a lot of those days. On a balcony of the hospital, sipping coffee and chatting idly about nothing. Staying up until 4AM together on call and bordering on delirious while still consulting on patients in the emerg. Walking out of an unsuccessful code together and sharing a grimace before we go back to work. Delivering babies and crying with the family in overwhelming joy. Holding a palliative patient while she cries about the children she will leave behind in mere weeks. Retracing in surgeries, attending teaching rounds, and floating down hospital and clinic hallways with the absolute certainty that I belonged there. Good years of certainty, knowing that I had one job - to learn to be a good doctor.

Apparently I've now learned. On May 24th I cross the stage and see almost all of my classmates for what may be the last time as we get minted as the newest batch of doctors.

It's also the end of my time in Hamilton. I've been a Hamiltonian since I was 12 and moved from Toronto. 14 years in 'The Steel City'. I call it home. I still haven't packed! It's going to be a bloody disaster when I come back from my trip. I haven't even packed for the Italy trip I've been dreaming of and my plane takes off in 17 hours.

I'm leaving my boyfriend, my best friends, my parents all here. Every doctor I know, every professional relationship I built, and every restaurant I've become a regular at are all being left behind. I'm moving to a land of ice and snow, where the tires are studded and the weather is freezing. But hey, I'm doing this willingly.

Hence the happy part. Comfortable is as comfortable does, but there's a little voice screaming 'adventure! Adventure! Adventure!' and it's only amplified in the last years. It's a harsh adventure, it'll be a hard adventure, but let's go for it.

Today I was also on campus for possibly the last time. Since my first days in Hamilton I've dreamed of walking on McMaster campus as one of the health sci students. I spent my high school years flitting in and out of Mac for performances, exhibits and science classes. Then I was a health sci for 4, glorious years. 3 more years in the promised land of med students.

Everything ended today. My last night in Hamilton. My last day on campus. My last time lying on this couch and typing on my laptop. I've been on the verge of tears all day - although some of that is just because I wrote the exam today. (It was like pulling teeth.)

Preparing for the journey: T-29 days

There's an entity known as Match Day (yes with the capitals because it's That Important) in Canadian medicine training. It's the day that months of fussing over personal letters, sleepless jetting across Canada for interviews and toying repeatedly with a rank order list pays off (or not) for residency. It's the day that medical students across Canada open their browsers and make a bee-line for CaRMs website. It's the day that we found out where we go for the next many years of our lives. Which specialty did we match to. Which school decided we were worthy of being trained to be Real Doctors.

March 1st passed, and the dust is still settling. Me? I'm leaving my comfortable Southern Ontario burrow and going to the east. Way, way east. I landed on the mainland and haven't left it since 17 years ago. This summer I'm packing up and moving to Newfoundland. It's a little daunting.

The number of times I've had to explain that no, I'm not being forced out there. No, it wasn't the bottom of my list. Yes, I really made it my first choice on the rank list is impressive. Something about me doesn't scream island life, apparently. Maybe because I finally bit the bullet on going rural. I've loved rural and done rotations rural since early medical school (was that 3 years ago?) but the prospect of fully committing to it still seems like a big step.

Taking that step all the way across the country. It's gonna be exciting. At least I have an apartment so I'm not homeless now. All the fish I can eat.

To the east coast I go!