Taking it up a notch

The first month (has it already been a month?) back at school has been going well so far. I made it through two weeks of neurology and two weeks of surgery seminars and anesthesia. Anesthesia was really fun with lots of teaching, opportunities to do IVs and intubations, and talk to patients. Next week I start neurosurgery, a rotation that is notorious for being particularly harsh; a brutal combination of long hours, little responsibility and brutal bedside grilling.

I have been doing well when I am actually doing things, but when I am idle for more than a couple of minutes I fall asleep. In one particularly embarrassing instance I dozed off right next to an anesthetist that was giving me and two other students a talk about chronic pain. I am just thankful I didn't start snoring. With 6:30 starts and lots of standing around doing nothing, I am a little nervous about neurosurgery.

The little guys has been smiling for quite awhile and will chuckle occasionally now, but whenever we pull out the camera he gets more interested in staring at the lens. This is the best I can capture so far.

Consult Rage
I had my first bout of consult rage last week. It is sort of like road rage but instead of wanting to tap on the window of some horrible or overly aggressive driver and ask them what they could possibly be thinking, it makes you want to call up a doctor and ask them where they went to medical school. It probably didn't help that I was called to see they particular patient just before I should have been sent home.

I was on call for neurology and was asked to see a guy in his mid-60's (details have, of course been changed to protect anonymity). He had been in a car collision a couple of days previous after blacking out (most likely syncope from 3 different hypertension medications) and running a red light. He had come to emerg and check out fine. The next day he saw his family doctor and promptly sent back to emergency for left sided "weakness". He was seen by neurosurg, had a head CT and C-spine x-rays and had been signed off.

And yet they still consulted neurology. I can only presume that they thought this left sided "weakness" was due to a stroke. Except he did not have weakness and never did. English was his second language and when he said weakness he just meant he couldn't use that side properly due to pain. This took me all of 30 seconds of extra questions to figure out. On motor testing the strength was fine, just limited by all the bruising from the collision. So neurology was consulted on a patient already deemed healthy by neurosurg that had no neurologic symptoms.

I might not have been so upset except for the extra hour (mostly spent waiting to review first with the resident and then with the attending) it kept me away from home.

On the up side that patient thanked me for being the nicest doctor he had seen in the 26 hours he had been in emergency.

One week down, 25 to go
I am now into my second week back at clerkship. Things are as well as can be expected. Most people seem to be a mix of impressed and horrified when they hear I have returned with a two month old at home. Most relax noticably when they hear that I left my little guy in the care of his father. (I am not sure what terrifying alternative they were imagining.)

After some initial getting-to-know-each-other-and-the-bottle adjustments the guys are doing well. The little man learned smiling a couple of weeks ago and is making great strides in his laughing, which is probably the best way possible to come home. It also isn't so bad to come home to a hungry baby I can spend a little time comforting either. Right now I am writing in the doctor's lounge, 4 hours past my longest time away from him. He will probably be in bed by the time I get home so I am actually looking forward to tonight's 2am feeding.

I can't say that I was an all-star clerk last week, I tend to be much more of a go-getter. But no-one died or was neglected and things are more on track this week. I have been more on the ball at the bedside grill sessions and am trying to work my way into presenting at grand rounds on Friday.

New pictures will have to wait until I am on my own computer.

Returning to the grind

I am in the middle of my last week of leave. In 4 short days I return to clerkship.

Just about everyone asks me if I am looking forward to it or dreading it. Of course I am dreading leaving my son for 8-12 hours per day. It is not like I am leaving him on a doorstep or sending him down the river in a reed basket. He will be at home with his very capable dad. But I won't be there to see him learn every new thing or check his stool.

I am also dreading trying to pump 3 times a day while at the hospital. I am not sure if there is anywhere half decent in the hospital to do this. And, as a clerk, I have no control over my time. It will be an interesting challenge.

But I am looking forward to getting back to medicine. To having adult conversations. To learning new things myself.

Of course another pic of the little lad; in a onesie from his aunt.

3 weeks as a mom

I knew that having a baby would change my life. I knew that it would change what I do in the day, how I manage my time, and a million other little things.

I wasn't entirely prepared to have mommy-hood change me. I think I underestimated the change in priorities, the change in how I view my family, how I view myself. Everything for my body to my dreams (both the night time and prospective variety) has changed since I gave birth. Looking back now this completely makes sense, but I don't think it is something that you can quite prepare yourself for ahead of time.


Right now it is storming outside - for the first time ever I am appreciating the wisdom of an attached garage. Unfortunately I don't have one, so I am going to postpone taking my three week old, fragile to the elements, infant outside until it is over; or maybe until tomorrow depending on how he feels.

During our late night feedings/conversations the baby and I have made a deal. I will feed him whenever he wants, make sure he is clean, comfortable, warm, let him pee on me, spit on me and do everything I can to make sure he stays healthy and happy and has everything he needs. His part of the deal is to keep breathing on a consistent basis.

And of course another picture. These are already a couple of weeks old and he has changed a bunch. I will have to get some new ones to show how chubby his cheeks are getting.

Mommy - hood

Thanks to Dragonfly for the link. She has noticed the medical baby boom taking place in the blogosphere. The same thing has been happening in my medical class - three babies in the past month; I think we are up to 5 this year. Because DF requested - and because I just can't resist - here is another look at our bundle of joy, taken by a good friend of ours that has a knack of capturing baby personality.

The baby arrives

I gave birth to my first baby - a boy of 4115g - on September 17th. I got a little more exposure to different obs/gyne techniques than I would have liked (it ended up being a forceps delivery) but everything turned out well in the end.

Here is the stinker with my husband on day two.

The World's Most Pregnant Med Student


I am now 38 and a half weeks pregnant. I have had a near dream pregnancy but I am now starting to feel the affects of hauling an extra 35 lbs around the hospital. Fortunately I am on a much less demanding rotation than my last one (neuro consult vs ICU). Unfortunately I am now in a much busier, more crowded hospital. I have had more strangers come up and touch my belly in the last week than all the rest of the my pregnancy.

Aside from the regular excitement over a new life, people, especially other health professionals, are fascinated by my reproductive state while in medical school. I will never get used to people I have never met asking me what my future career plans are while riding in the elevator.
"How can you manage?" "Are you going to take time off?"

I can understand why people are curious. I am a bit of a curiosity. (Step behind the curtain to see the World's Most Pregnant Med Student. Watch while she writes consults on her shelf of an abdomen. Beware the massive swinging belly.) But I am starting to wonder why they all ask me about it. It is interesting how introducing a baby into the picture gives people permission to cross regular lines of privacy.

Addendum
I guess my fears were unwarranted because my evaluation actually went really well.

Next week Neurology; a rotation where I would really like to make a good impression. I don't think the neurotic self doubt is going to end anytime soon.

(~) 3 weeks to go

I just passed the 37 week mark until my due date. At least from my one of my due dates. It depends on if you go by my ultrasound (at 18 weeks; not very accurate), my last menstrual period, or my ovulation date by body temperature. Either way my baby is pretty much considered fully incubated at this point, but could still chill in the womb for up to a month yet. I will post another belly picture when/if I have time for a mirror photo shoot.

On the med school front, today was my second to last day on ICU. I picked ICU as a selective during my internal med rotation so that I could get a little more comfortable with really sick patients and some more complicated problems. I also heard that it was a good place to get a few procedures under your belt, that the days were long and tiring but that, generally, people don't do call.

I haven't done as well as I would have liked on this rotation. 4 weeks later and I have only done a few central lines and attempted one intubation. I have stayed late a bunch of days (I drew the line at over night call at 33 weeks) and I did some weekend call. Despite what I think has been my best efforts, I haven't learned as much as I would have liked or done as much as I think I should be able to do. It doesn't help that one of my most recent patients has plateaued, refusing to get any better for the past four days no matter what we do, and the other failed her extubation yesterday even though I was sure she was doing better.

Today I rushed off to my doctor's appointment (they fit me in extra at the end of the day) and only realized on my way home that I had forgot to finish the note on one of my patients. Not the best way to finish off the rotation. I went back to the hospital to finish it but the attending had already been there to do it for me. I feel like a total schmuck. I guess I will find out at my evaluation if my staff thinks I am as big a failure as I feel.

I am on call for internal medicine teams. I should be sleeping right now, between pages informing me of random numbers (sats, oxygen requirements, blood sugars) about patients I haven't met. But I seem to be too keyed up and there is a computer in the on call room, convenient for those people that can actually use it to enter orders etc (as a clerk I need someone to verify everything me so it is not so useful).

For those non-medical types out there let me explain briefly:

Internal teams is in house call. Which means I am in a room in the basement of the hospital that looks a little like a rather nice room at a hostel, or a really crappy hotel, or a sparsely stocked bunker. Aside from the computer, there is a lamp that doesn't work and a phone - the other implement they give us to make sure that we can respond to any page within minutes. I still have to search out some blankets so the single bed only has a small pillow on it.

I am on with a junior resident from my team (go gold! I was told they switched numbers to colours to distinguish the teams because team one would get all the patients) and a senior that is over seeing us and the resident from green team. I or the junior get messages from the units about patients that our admitted under our team (at last that is the theory, about 1/3 of the calls I get are actually about the other team). Sometimes it is just a phone number to call back, other times it is a very short text about some concern. Other times it seems like random numbers and letters. Like "Pt DW c/s 13 sat89 ventolin?" (*Not an actual page, just representative*). Believe me when I say this doesn't make sense even if you know what the short hand is.

At least I am not the junior resident. They can enter orders so they also get all the "can we get a gravol prn order for so and so" calls as well. All very necessary but not what you want to be woken up with 5 minutes after laying your head down.

Our other duty is admits. The senior residents takes consults from emergency and, if they think they should be admitted to internal medicine, we go and take a full history, do a physical exam and take a guess at what we should do with them. In the best case it is 9pm and we are the third medical person (after the ER doc and senior resident) to talk to them. More likely it is midnight or later and we could be the 5th or 6th (after a ER resident, the ER staff, the senior, another specialist or two). I was 5th in line today. So the very nice lady with shortness of breath was being rather patient answering my questions 2-3 words at a time in between her gasping inspirations.

And I get to do it all again the day after tomorrow... no I mean tomorrow because it is already tomorrow today... you know what I mean.

Hhmmm...

Here are some of the comments I have gotten over the past few days:

- Boy, you're getting big
- Are you sure your not having twins?
- I thought you said you were due in September
- I didn't realize you were getting so big in profile
- It looks like you are about ready to burst
- Your bigger than all the other pregnant women (They were in the hospital for their prenatal class and I had a hard time convincing the cafeteria lady that I was working there, even though I was wearing an ID badge)

But my favorite came today:

- Are you sure you are going to make it through tonight?

12 more weeks to go.

No Place Like Home

I usually think that, were I to win a couple million dollars, I would stay in school. I really enjoy what I do and I want to leave my time on this earth having contributed something. I don't think being a physician is a higher calling or anything, but I do think it will give me opportunities to make a really differences in people's lives.

But if you had given me the option of staying at home and only worrying about the people and concerns within those 4 walls, I would have ditched every higher ambition and be happy for it.

Adventures in Gestating

25.5 weeks

I have started to wonder if people are treating me differently as a med student because of my expanding abdomen. Being new to clerkship, I don't know what it is like to be on these rotations without a fetus brewing, so I really can't really judge. But I think it is coming up in more ways than I expected.

In some ways I am think I am pretty fortunate. The nurses seem to be nicer to me. And, while I am in pediatrics, I seem to have a pretty easy time getting a history from some of the mom's. There is that "you're a mom, you know where I am coming from" feeling of sorority. Especially the new moms that are freaked out and worried about their kid but also freaked out and worried that they are freaked out and worried about nothing and wasting your time and you are going to think they are neurotic fools. Or maybe I am projecting a bit.

But there is also the other side. I am not sure if I am getting all the work or opportunities that I might if I wasn't lugging around an extra 30lbs. Are people "going easy on me" at the expense of my education and reducing my chances to make a good impression? To compensate I have become much more of a brown nosing pain in the ass than I would normally be inclined. You know the type - following around the resident and the attending like a bad stench and jumping on any possible case.

I was pretty happy to get out of my teaching half-day early today. Maybe I am back to my old self. :)

Steady as she goes
You might think that I would have lots to blog about. I am now 24 weeks pregnant and into my pediatrics rotation for clerkship. But, things have been pretty uneventful lately. Being at the kid's hospital around some really sick kids for most of the day has caused me to have some pretty reactive emotions, but that was expected. I doubt there is anyone with a heart that could witness a newborn having seizures everyday or a 2 year old that hasn't progressed past the development of a 1-month old and not feel it. But I am sure, with all the hopes and expectations I have for the little one kicking away at my ribs (not to mention the hormones), that I am a little more susceptible to this particular heart break. So I will tell one quick story.

I am on pediatric neurology and last week we diagnosed a 3 week old with tuberous sclerosis. On the scale of things, this wasn't nearly the worst case I saw but the discussion with the parents during which we told them the diagnosis will stay with me for a long time. TS is a disease where you could live your life not even knowing you have it. Or, on the other end of the spectrum, you could be developmentally delayed with behavioural problems and have to struggle your entire life. Given that this child was already having seizures he is probably going to have a harder road than many others. All these parents want, like probably any parent hopes for, is to know that their son is going to be okay. They would like him to be "normal" but, as time went on and they understood the diagnosis better, I think they just wanted to know that they would still have their child, the little boy that they had gotten to know over the past 20+ days.

One more week
My psych rotation ends a week from tomorrow. Most clerkship psychiatry rotations are largely inpatient following a specific staff psychiatrist, but mine has been almost exclusively outpatient. I do assessments on people referred either through their family doc or emergency. We make medication recommendations and then I see them a few more times to do a clumsy attempt at therapy.

This might be appropriate for some people that have short-term crisis-induced problems. But many of the people that come to our service have long standing interpersonal, personality and mental health problems. I feel bad that some of these people wait a month or more to see a psychiatrist, hoping that they will find a way to dig themselves out of an existence that has become painful and hopeless.

And then they end up with me. For a few weeks.

Like baby beluga's mom

I am feeling particularly pregnant today. For the past month or so I have been feeling very good. I had a few rather unpleasant weeks in my first trimester but that passed. Aside from a nearly insatiable thirst and having to buy all new stretchy clothing, all of my pregnancy "symptoms" have been more of a fascination than an annoyance. Today I noticed that I have really slowed down. It took me nearly an hour to pick up groceries this afternoon, waddling down all the aisles and stopping to take my 5 hundredth pee break of the day.

There is an upside to being the size of a marine mammal. I actually had a guy offer me a seat in a crowded downtown coffee shop. A courtesy I thought had passed with cassette tapes. He was done his drink and just sitting there reading, but I was still surprised.

I am just over 21 weeks into my pregnancy, which means I am just over halfway through being an incubator to my peanut. This recent gearing down makes me a little nervous about clerkship for the next four months. I am not sure how four weeks in the ICU will go when I can't stand for more than 20 minutes and I am headed to the washroom at least once an hour. Thankfully my school is being very flexible. The peanut and I will take it as it comes.

Hi from the Peanut


As almost everyone who reads this blog probably already knows, I am expecting my first child in just over 4 months. My husband and I are thrilled and excited but, like most first time parents-to-be I suppose, we are also freaked out, worried and afraid.


I am on my psych rotation presently. This week is my week to be at the kid's hospital for the children and adolescent psych portion of my rotation. There is nothing like hanging out at the kid's hospital to make you acutely aware of how vulnerable children are to all the chemicals, germs, accidents and whims of fate or genes. There just seems to be too many things out there to protect my little peanut from. And plenty that I don't even have a chance against.

I have tried to be a good mother to my parasite so far but, as evidenced by my posting at nearly midnight on a weekday, I haven't been perfect. I feel guilty every time I have pop instead of water or give in to my desire for a bath instead of a shower. I know feeling guilty isn't particularly helpful and I know no parent is perfect. But I also know that, even if I am perfect, there are all sorts of horrible things that could befall my peanut. So isn't my responsibility to make sure he/she has the best chance possible?

My next rotation is pediatrics; three weeks of neurology and then three weeks of general inpatient. I have already warned my husband that there might be a lot of tears coming up.

Night in Emerg
Yesterday I had my busiest night in emergency so far. The department I am doing my elective in is divided into two parts, each with its own staff physician, usually a resident and, lately, me. One part is more ambulatory cases: things like lacerations, minor muscular skeletal, minor abdominal complaints (at least as far as can be determined at triage). The other side gets the more major cases: resuscitation, possible cardiac or stroke, older more complicated patients, people who are likely to be admitted or at least need a consult. I was on the later last night.

So far I have preferred the ambulatory cases. They may be more minor, and sometimes there is nothing that can be done. [Three days of sore throat in a 27 year old without a fever or other sign of systemic disease is going to get a throat swab (at most) and a push out the door.] The only skill needed in those cases is the ability to explain that the need for antibiotics is not proportional to the time spent waiting. But stitching someone up, solving a defined problem in a single shift is satisfying. At least there is resolution.

I have been unlucky on the major side. The cases I have been getting are ill defined, inconclusive and, in many cases, not real (the overdose vs seizure later admitted that they faked the whole thing for a love interest). Last night was busy and I had the real feeling like I was working through medical problems to the benefit of the patient. This is what drew me to emergency in the first place. History - physical exam - differential diagnosis - thoughtful use of tests - diagnosis and plan.

Don't get me wrong. I am not one of those students that prays for a major accident or the acute onset of a dramatic deadly condition just for the sake of my learning, or the adrenalin rush. I would just as soon have your chest pain be some minor angina rather than a dissecting aorta. I don't wish for more sick people in emergency (at least I try not to). But I was starting to get a little sick of the people that were showing up at emergency because they felt that their family physician was not listening to them about the arthritis they have had in their knees for the past 5 years. Especially when it takes 20 or 30 minutes, and three stories about their grandchildren, before they tell me that.

Homeward bound - one more week
(This will have to be a short one because I am running out of battery.)

One week down, one more to go. If it sounds like I am in count down mode that is not a coincidence. After 5 weeks from home I am ready to sleep in my own bed, cook on my own stove (I never realized how much I hate electric), see my cats, walk my neighborhood, go to my favorite restaurants... well you get the idea.

This elective has been fun. The great thing about emergency is that it is always busy and things pass quickly. But between the new place, living in a dorm, and doing shift work I am starting to feel disconnected from my regular life. Some people like the quote that goes something like "you should do something new everyday". I am tired of doing new things. All I do is new things. I want to return to some routine. I need to refind myself in all the familiar comfortable things that I surround myself with at home. Not the least of which being my husband.

Two Down, One to go
Despite my original good intentions I have fallen into my usual negligent pattern of blog posting. In the meantime I have completed two of the three electives I am kicking off clerkship with.

The first was internal medicine in Kingston. For the first week I did emergency consults for the medical teams because my preceptor was away on vacation. You may ask why, for a two week elective, they would place me with a preceptor that was going to be away for a week. That would be a good question, for which I have no good answer. When she returned I was in "general medicine" clinic with my preceptor for the rest of the time. My preceptor is actually an endocrinologist so almost all of her patients have endocrinology issues. I am horrible at endocrinology; I am taking the experience as a learning opportunity that I would normally avoid at all costs. I also got practice at dictation. A skill that has already served me well and is something that I wouldn't have done unless forced.

All things considered, it wasn't the elective I was hoping for but it turned out to be good preparation for my next elective. I practiced a lot of skills: history, consult notes, orders, dictations, clinic notes, presentations.

My next elective was neurology in Toronto. I had a great experience doing my pre-clerkship elective in neurology in Calgary so I was really looking forward to it. I was apprehensive as well. Neurology became my first choice of specialty after the great experience I had in home town (and my psych experience was less than ideal, but we won't talk about that). Between desperately wanting to impress, I was also a little nervous that this elective live up to my expectations. I didn't want a really disappointing experience to cast me into a sea of self doubt and indecision.

I had a good time. It wasn't as much fun as my previous elective in neurology, mostly because I didn't get to see as many patients as I would like. This is a perennial problem in Toronto, which has a reputation for being overrun with trainees at all levels. Despite not being as hands-on as I would have liked, it was a good elective. I enjoyed clinic and inpatient, and I found all the cases really interesting.

Tomorrow I am off to Winnipeg for two weeks in emergency. I am also really looking forward to this elective. But I a have to opposite problem of my last elective. Emergency has been on my list of possible preferred specialties for awhile, but has dropped down to a distant third behind neurology and medicine. My goal is to learn lots, get a good reference letter and have some fun in emergency. But, if I have a really good time, I will be back to not knowing what I should really be putting my effort towards. I can't be really competitive for both neurology and emergency and I really have to make a final-like decision.

Ahh, the self absorbed second guessing and self doubt of a med student. Where would we be without it?

Clerkship day one
I can't say that I was any kind of rising star today; but all in all I am counting it a success. No one died, no one cried. Aside from a brain freeze here or there (what do you call that area that you tap to look for kidney tenderness??) I think I even managed to look slightly less like an idiot by the end of the day than I did at the beginning. I even had a patient compliment me in front of an attending. I can't remember the name of the attending right now, but regardless. Most importantly, I have a couple things to look up to try to look smart tomorrow. Right now though, I think I have earned a nap.

New place, new challenges
I made it to Kingston (Ontario, not the sunshine and rum one). I start my first clerkship elective tomorrow. Aside from being generally assigned to Internal Medicine and a mission to the Undergrad medical office to finish paperwork tomorrow morning, I have no idea what I am doing. I don't just mean that there is so much to know that I am assured to look like an idiot, though that is true too. I mean I don't know where I am going, or who I am working with, or what I am doing. In-patient, out-patient, what clinics. It's a huge mystery. Hopefully it is not too much of a disaster and I will have some time to let you know how it is going.

On another note, it is always interesting to see what differences you notice when you travel. I went on a short hike to the grocery store this evening to get some supplies for tomorrow. Two things that struck me right off the bat:

1. the roads here are completely bare of snow and the sidewalks are a mess. It is obvious that it has snowed here a fair amount and, without friendly Alberta chinooks, it has stuck around. While the streets seem to have been plowed by a magic truck that even scoops out the potholes, there is slush and ice and treachery on every side walk. Maybe there are no old ladies to break their hips here, or may be the students that live in the houses just don't care.

2. milk costs twice as much. I am sure there is some fascinating history about farm legislation and price control but geeze, x 2 seems a bit steep.

There is lots of cool things here too, cute old houses, good restaurants, blah, blah; but that is what I have noticed in my 3 hours stay so far.

No Big News
It is not that there is nothing significant going on, there is lots, but I am not ready to talk about any of the important things things happening in my life. So I will post about blather instead.

My husband went away on a business course this week. I used to think that I was a capable independent woman. I can handle stuff. You stick me in a clinic I have never been in before and put a patient in front of me I can do (in most cases) a decent interview and physical exam, even have a good idea of what might be going on. In a week I am going away to a city I barely know, to a hospital I have never been in to do my first clerkship elective and I will handle it. I am the queen of handling it. At least that is what I thought.

I don't think I take my husband for granted. I thank him all the time for all the stuff he does around the house and tell him how much I appreciate when he listens to me rant about school or traffic or politics.

But he has been away for two days and I am already struggling under no longer being part of a couple. Maybe I am not suppose to say this as someone who thinks of themselves as a feminist, but I really depend on my hubby. After all, does anyone really enjoy doing their own laundry. Now I have to wash the dishes myself after making dinner, and there is no one but me to feed the crying cats at 6 in the morning (don't they realize it is Sunday and I was out till one last night). Division of duties is not just an efficient way to set up an automobile factory, it makes my life a lot easier.

I sure hope he deals better when I am away on electives. I can't actually remember the last time he cooked. I just hope he doesn't starve to death, or give himself liver failure from too much space cheese at Tubby Dog.

Final course
As a second year student (in a three year program) I am in my final course before starting clerkship. Yay!

About 4 more weeks of lecture and small group, and then another few weeks of integrative (a vague, small group, problem based entity) and we will be thrust into pretending to be competent almost-physicians full time.

On another note, I have become unnaturally interested in the American presidential race. I guess I can partially justify all the time I spend checking polls, primary results and pundits overstated opinions with the whole what-happens-in-the-giant-empire-affects-the-mouse argument, or that I am a victim of trends in mass media. That all maybe true, but I tend to view the whole thing as entertainment. The soap opera story lines are riveting, I get the updates in easy to manage 2-3 minute increments and the characters are way more outrageous than anything on Canadian tv or writerless network shows. Or maybe I am just giddy that Bush will eventually, finally be replaced.