It's been a long time and a long journey. To briefly summarize I've realized the rural and remote life isn't for me. I made myself believe that's what I wanted because it's what 1) my former partner wanted, 2) what I thought was the safest and most steady career path, 3) I wanted to be the most well dressed, biggest fish in the small pond deal.
What I've realized: 1) a partner can't make up your whole life, and he/she should push you to be better than who you are. Sure, they should accept you, love you as you are, but having them in your life should make you want to progress, be better, journey together without stagnating in a rut relationship. 2) Safe and steady is not what I want. I came to Newfoundland to be challenged. I came to be pushed out of my comfort zone and to learn things I could never imagine I didn't know (insert things you know vs things you don't know speech here). That leads to an unfulfilling career that, no matter how much I tried to engage with it, just didn't seem worth it. 3) It's no fun standing out for reasons no one else considers as valuable as you, and when you're the biggest fish you have nothing left to push you to evolve.
What I've done: 1) My ex partner and I had a long discussion, over the course of over a year, and decided that love alone isn't enough. You can't love each other out of depression. You can't love each other into a meaningful career. You definitely can't rely on romantic, got-to-have-you-can't-live-without-you love to get through the mundane hardships of day to day life. 2) I wrapped up my residency - finally! - but chose to commit to a +1 year of enhanced skills on a whim. I hadn't intended to after having such a challenging time in rural residency, and never imagined I would be interested in flinging myself even further into rural Labrador and (!!) rural Nepal. I imagined going straight home to Ontario, starting locums and settling back into my old life. Then I thought, I left Ontario and home for a reason - that being I wasn't satisfied with just the status quo. Yeah, my circle of friends, cafes and visits back home to mom's backyard patio was wonderful, but if that alone satiated me I would have never left. I was incredibly offered the +1 year based in St. John's and, after about 30 seconds of pondering, said "hell yeah let's do it!", with my new partner. He's made the questionable decision to jump his own ship and come out to the island with me, so we're quite the match. And he is absolutely someone who makes me want to constantly improve and explore myself. 3) I'm the newbie all over again, I know nothing of refugee health, transgender medicine, care of the homeless from residency. My starting base is lower than I've ever known it - and I love it. I'm being pushed to learn again, to enjoy learning again.
Now it's time for the blog to take a different turn. I would still like to write reflective pieces, but I'd like to do a weekly-biweekly summary of my patient exposure (privacy protected of course). Personal life will always be intertwined, because to me you cannot know yourself as a professional without accounting for your personal. We don't evaluate our patients only based on the story they present us in clinic, we remember their family relations, their job concerns and their support circles. In my thinking, my relationships, my personal wellness and supports are just as significant determinants of me as Dr. Z.G.
Wednesday, July 15, 2020
Monday, November 26, 2018
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.
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.
Sunday, October 7, 2018
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.
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 |
Wednesday, October 3, 2018
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.
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.
Wednesday, August 22, 2018
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.
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.
Sunday, August 19, 2018
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.
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.
Friday, August 3, 2018
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.
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.
Subscribe to:
Posts (Atom)