Stories from training

 My learners seem to get a kick out of my misadventures in training, and as I age I forget more stories. Maybe it's time to start writing them down.

You know how they tell you to make patients show you how they use their puffers? Precovid world? 

Yeah. Do. A patient admitted for recurrent COPD with a significant language barrier showed us - his very confused care team (his treatment is maximized! Why is he flaring?) - how he uses his puffers.

Spritz spritz x3 into the air in front of him. Then he leaned forward and took a deep inhale through his nose. Maybe one step above people who are satirized to use puffers like perfume.

Us: "..........oh" 

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Speaking of language barriers: I once saw a lovely Chinese patient who spoke a little Mandarin, a lot of Cantonese. Her friend/interpreter spoke a little of English and a lot of Cantonese. I speak a little of Mandarin and a lot of English. So it went in a 3 way circle of me saying something in Mandarin or English, the two of them translating for each other, then each giving me half a sentence. 

I misplaced the word for "bladder" in Mandarin. As if I ever knew it. I told her the problem was her "plastic bag that holds urine". She was understandably confused. 

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One would like to think those who are multilingual sympathize with others who speak English as a second language. A preceptor and excellent physician who is of Brazilian origin turned to me and asked if I could speak to a patient who only spoke Vietnamese.

"I speak as much Vietnamese as you do?"

"Oh you don't speak 'Asian'?"

"...do you speak 'South American'?" 

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A delightful preceptor, probably in his young 40s at the time (he seemed so old then! Now I think he's pretty young) called me into his office one day. His office is very small, holds two people, and has no window. He closed and locked the door as I went in, and I thought for sure he was going to rip me apart for a patient or chew me out on a case and fail me on the rotation. 

He looked gravelly at me then asked, "so what exactly is a Dank Meme?"

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Adult friendships and loneliness

 Unrelated first, I'm getting back to cooking Stardew after spending Christmas as a hermit at my parents'. Also known as I didn't have to cook since my mom is an excellent cook. 

I made "omelet" today. It's in quotation marks because I cheated a bit and made Japanese rolled eggs. Tamagoyaki. Sweet, savoury, delicious. It was fun to make - although the rectangular shape of the pan meant that my hands were getting a bit toasty with my circular shaped stove top. 

I still plan to cook regular omelets since I've never successfully made one of them - a lot of "intentional" scrambled eggs were served instead. I don't even order them in restaurants often - I've usually gone in for steak or some other meats instead. The lactose intolerance has a lot to do with it but really it's because I like meats for breakfast and omelet doesn't come with enough meats in it. 

For my rolled omelet I wanted to use the rest of the Japanese cooking tools for some kicks. So I made some onigiri - loosely termed because really I just made triangles of left over rice. They weren't holding together since it's just rice of the fridge, so I fried it and made a bastardization on the level of Jaime Oliver's fried rice of yakigiri. 

On the actual title, it's really hard to make friends as an adult. Or is that just me? I almost wish to have a child so I can have a way of meeting friends. I feel like the last time I had ready made opportunities to make friends was residency. I certainly met some great people during that, but the majority of people around me were not from the same planet as me. I don't know if it's them or me that's weird, but that's a trauma for another day. 

Let's break this down, and let's do point forms like a SOAP note. 

1) Work

- difficult because of the power hierarchy

- this was much less pronounced on the island and rurally, but here there are clear distinctions based on the letters behind our names 

- I get along well with several of the nurses, who are absolutely lovely humans, and wish to get to know them better 

- unfortunately they only call me "Dr." and our interactions are fairly well limited to the clinic 

- I get along great with the residents, they're right around my age, me being freshly out, but that's an iffy boundary to cross

- I consider several of my preceptors from Newfoundland friendly, but even there they were my preceptors, let alone here 

- other physicians? I've gotten to know a few of them, and another locum and I have made decent acquittances 

- COVID has limited our ability to meet on any regular basis or indoors unfortunately 

- if this was a a relationship and dating, we'd only be on the third date, still trying to figure each other out bit 

- other physicians that I do well with all have kids and families and lives of their own

- they're all a few more years out than me and usually leave work to be with families 

- I guess I can say I have more freedom and free time but no one to share it with 

2) Clubs/hobbies 

- COVID LOL 

3) Friends of friends 

- would you believe the cruel twist of fate that as I moved to this city my good friend who was here moved to Vancouver, and other good friend moved to the east coast on an island? 

- my partner's friends are all in Halifax, and while I enjoy their company Halifax is a long ways away 

- the rest of my friends are on the other side of Toronto (also known as the black hole of traffic) and COVID LOL

4) Cafes/bars/restaurants 

- COVID LOL

Okay so a lot of it is COVID. I feel like I need to ask people for a rapid antigen test just to let them in the door these days (as if you can even get one) but without children and as people around my age start to have children, and as old friends start to move away and drift away, what's left? I feel like I never had as many close friends as when I was in high school. The numbers just kept shrinking from there. So I guess I peaked at 15? 

Stagnation or evolution

 So long ago (read: pre residency) I was a very different person. There's nothing wrong with that, and there's nothing wrong with change. I would even venture to say that not changing in the face of significant life events may not be healthy. That said, at what point is it settling and stagnating instead of actual change and evolving? 

While cleaning my closet today (theme of the year is organization and beauty!) in a bid to make my life less chaotic I realized something. I once had 20 pairs of lacy underwear for no purpose other than because they're beautiful and that I'm happy wearing them. I counted 4 today, none of which I particularly like. Am I really living a more minimalist lifestyle or have I let 2 years in social isolation - even pre-covid - stop me from being me? Am I really okay with not wearing stylish, fashion forward dresses because I've evolved past them? Or do I just still hear the catty, backwards voices of a toxic workplace bitches ask me if I'm dressed like that to entice patients and other physicians? Am I just letting those past traumas (having a coworker loudly point out my nipples in a dress in a busy ER where I was staffing) determine what I still do or were those just formative experiences that changed me for the better? Am I actually happy with who I am or am I merely stuck in a stagnant puddle? 

I used to think I evolved past them. It turns out I might just be still stuck waist deep by past shit. So on the theme of living a more beautiful year, whatever that might mean on each given day, I'm throwing out all the old clothes, underwear and all, and buying some new, beautiful clothes. 

"If you can't love yourself how the hell you gonna love someone else?"

Who knew the best life advice I've ever gotten would come from a reality drag show? 

Selling a student

 I once wrote a blog post (many blogs ago) about selling myself and how difficult that was. I was in the process of applying to residency programs as a senior medical student. I now sit in a faculty position (doctor? Professor? Both? Proctor or dofessor?) and have the immense privilege and delight of having students. 

One of my students has asked me for a reference letter. I said yes maybe a little too enthusiastically. 

I remember the distinct squirming of asking former preceptors to recommend me to residency programs. 

"Excuse me sir, I know you only met me for half an afternoon but that's longer than anyone else I've met on this rotation - can you please write me a reference letter?" 

Minor exaggeration, but not by much. 

Whatever I can do to ease the learners' hell on earth known as CaRMS, I'm excited to do. 

That said I'm confronted by the expectation of these letters. I didn't know what the process entailed when I asked preceptors. Apparently we can't just write "so and so is a great student", but have to write "they were AMAZING" "top 1% of all learners" "superior in every regard". Except if I write for more than one student they can't all be the top 1% and best I've ever worked with. I certainly can't make constructive comments like so and so faced some minor difficulties in this but showed rapid improvement, even though that, I think, is a glowing recommendation that someone is ready to grow and learn. So facetious overexaggerations it is? 

Money vs Sanity

 Recently (only a few months into practice) I decided to decrease my work hours 2ndary to some increased stress at work. he stress was multifactorial and which I hope to have ameliorated the source of much of the stress, but a little extra time away seemed good for my psyche. 

On the flipside a good friend of mine is picking up every extra shift physically possible and working into weekends and nights, but somehow still fitting in shopping trips and new exercise classes. All this and my ever looming debt begins to make me wonder: am I just lazy? 

Is it overwork and burnout or laziness that's preventing me from getting through my workday properly? Am I really this mentally stressed after seeing so many patients that I can't do dinner or am I just too lazy to cook? 

I don't know the answer to that. I don't know if I want to know the answer to that. 

A related train of thought I've been having - would I be willing to trade some of these hours for a more physically active and less mentally demanding job? One where I'm not constantly worried about the effect of a new medication on someone's kidney function that's been on edge but who needs this medication so that they don't have a stroke and die but who also isn't sure if they really had a stroke and don't want the medication and why am I forcing them to take medications? Oh and they have this weird new bilateral numbness that may or may not be a pinched cervical nerve or cervical stenosis that may or may not need an urgent MRI or just general physiotherapy. 

I think my blood pressure went up 30 mmHg just writing that. 

I'm reasonably sure it would only take me a few hours of general labour work like drywalling or something before I scream with complaints of back pain and repetition boredom, but after a particularly mental taxing day and my pedometer only reading 1000 steps, I can't help but wish for something different. 

My partner thinks taking up gardening would be good for me. I say we're entering dead of winter in Canada and we don't have room for a Christmas tree this year because plants have already taken every available surface in our house...

But I digress. I'm taking some time away to do less work so that I don't spend all my monetary earnings on therapy. I've been trying to pick up my slack cooking again in this time. Believe it or not I used to cook elaborate meals to relax. You'd never know it by my instant ramen lunches. 

Lacking the drive to actually cook proper meals, I've taken to a cooking challenge I've seen some people do. 

So there's a game called Stardew Valley and it's all my fantasy impossible farmer/country living come to life. Having actually lived in a seaside small town, I can safely say the game is quite unrealistic in many aspects, mainly the part where people like outsides who move in...but that's beside the point. 

One part of the gameplay is cooking. It's not a huge part. You collect recipes, you collect ingredients, you hit cook, and you sell/eat/gift the dishes. But it has plenty of interesting enough foods that I'm keen to play around with them. Namely a bun, aptly named "strange bun" that includes some fish yet looks suspiciously like a meringue based dessert. 

I've started off easy. 

This waffle iron hashbrown isn't the prettiest thing I've made but it was tasty! My boyfriend who was already full up on several courses of dinner ate two of these average waffle sized potato creations. It take little other than a lot of shredding potatoes to thin, thin, thinner than julienne strings and crushing them in a searing hot waffle iron until it crispens. 

Apparently the trick is to squeeze out all the water. It may have taken entirely too many sheets of paper towel. 

https://www.seriouseats.com/waffle-iron-hash-browns-potato-recipe 

So the description for this roasted hazelnuts dish is that it tastes foresty...and it really did! It tasted like a coniferous forest after a mild autumn rain! Not that I've bitten many pine trees but I've taken plenty of walks and the air of this is reminiscent. 

I'm not usually a fan of hazelnuts but this turned out shockingly well. I'm not a fan of nuts period (they're too dry!) but this is easy to munch on. Sprinkled with some sugar and it takes on a light, aromatic and nutty flavour, sprinkle with olive oil and salt and it's delightfully umami and the natural sweetness of the nut pops more. Recipe and credit where it's due:

https://mayihavethatrecipe.com/how-to-roast-hazelnuts/

Next step: cookies. Ugh. I hate baking. Hate it with a passion. I'll labour over a carbonara or beef stroganoff all day. Leave the oven out of it. 

Shit stirring

 It wasn't that long ago that I looked down on the disdainfully termed SJWs - social justice warriors. The people who think we still need feminism or race equity or LGBTQ+ rights advocacy. I don't think it came from a place of malice - rather of privileged ignorance. And how privileged that ignorance is - to be a cis gendered "model" minority growing up in cosmopolitan cities with highly educated and cultured friends and family. 

I never thought of myself as an advocate, one of those bitter folk always complaining about the state of the world. It took being thrown into the world of the underserved - one where people are incarcerated for untreated mental illnesses, where being Indigenous sentenced children to higher mortalities, where people choose between medicine for themselves or food, where a country must beg tourists for its oxygen cylinders returned after mountain expeditions, and where young people are casted out of their families for the "crime" of expressing their genders and sexualities. It took diving face first into this world to even scratch the surface of advocacy and what "check your privilege" really means. Has it made me bitter? Oh yeah. Do I regret it? Hell no. 

Anyways, that's the tangential background. Recently I was called by a shit-stirrer - by myself that is. At the first clinic where I'm working as staff physician (can you believe it?!?) I notice things. I notice my residents being worked into the ground and losing their love of family medicine. I notice patients who suffer large gaps in their care. I notice clerical staff who need sick days every month for their mental health. I should say I support mental health days but people shouldn't be so overworked they rely on these days to survive the work. 

By nature of the training of my past year, I've developed a habit of speaking. Speaking up and speaking loud and speaking often. There are 3 or 4 strands of emails and conversations I'm having with people on issues I've detected. I've emailed the clinic manager probably more than anyone should. And the nursing manager. And the physician manager. And I'm about to email the resident manager. 

Am I a shit-stirrer? Probably. Does shit need stirring? I think so. 

A strange homesickness

 A little over 3yrs ago I landed on the rocky shores of Newfoundland, fresh off the boat/ferry from my home of Hamilton. For the first very many months I was in a state of constant culture shock and homesickness for my old lifestyle in Ontario. I looked forward to the day of residency completion and leaving the island behind forever.

A year ago I moved to St. John's and found a new home. Walking out on the streets felt as comfortable as walking my backyard. I lived in a beautiful apartment with a beautiful view. My mentors there are the giants whose shoulders I stand upon now. I didn't get to spend a lot of time there. A lot of my time was flung on the road for electives and going to Labrador. Maybe as a result of that, it feels like I've only tantalizing been allowed to know St. John's. 

I thought a month ago when I finally came home to Ontario that I would feel, well, at home. It doesn't quite feel like that. Hamilton has changed from when I knew it. My friends have moved cross country. I've even changed boyfriends. This isn't the same home that I left behind. 

When I first got to Gander I longed for Hamilton. Now that I'm back home in Ontario, my heart yearns for the island. 

Since we turned into Quebec my chest has ached every time I think of the ocean. For almost the entirety of the drive back from St. John's we were never more than a breath away from the ocean - whether steep cliffs or rocky shores. Every so often a turn of the road opened up the vista of crystalline blue before us. It seems so ridiculously sentimental and silly to actually miss the ocean, but it's my personal belief that anyone who doesn't long for the ocean hasn't lived for long enough beside the ocean. 

I'm now so deep inland that the only waters are the great lakes. They're not much to complain about - the Group of Seven made lake scenery a cornerstone of their masterpieces - but it's just not the same. I miss the sharp crevasses that cut through the Newfoundland coast. I miss the casual whale sightings and pretending to be able to distinguish a humpback. I miss the rocky landscape that are a geologist's wild dreams (or at least job insurance). I miss a sky that seems to stretch forever when it's clear, but also temperamentally throws everything from hail to sun in a single afternoon at you. I definitely (in this oppressive humidity) miss the cool breeze that rolls off the ocean waves. 

I miss the ocean the most. 

A lake - even a Great Lake's - gentle lapping of waves that is stirred only by a passing yacht or heavy breeze does not pull me in as the Atlantic Ocean's raging turbulence. The ocean's roar seems to drown out all anxieties, fears, and generally tangled thoughts in a way that nothing else can. The crash of waves silences all else. I miss the hypnotic boil of the ocean that almost urges you to jump into its icy depths. I miss the white crests and the glittering blue under sunlight. I miss the dark blue depths and terrifying blackness in the night. I definitely miss its temperature like that of liquid ice on a hot day. 

Life on the island always seemed to be so turbulent. Life here back "home" is...calm. Civilized. Like tepid bath water after hot springs and arctic pool plunges. I can't say I'm uncomfortable, but tonight I miss the outcrop of St. John's as much as I once missed the inner city of Hamilton.