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?
Monday, July 23, 2018
Tuesday, July 17, 2018
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.
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.
Saturday, July 7, 2018
(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.
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.
Thursday, July 5, 2018
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.
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.
Sunday, July 1, 2018
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.
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.
Subscribe to:
Posts (Atom)