Infection Control
This week there has been an outbreak of H1N1 in one of the wards of the hospital I work at. They quarantined the ward (no new patients, only staff that we necessary for patient care and only close family visitors). While H1N1 has been largely a mild disease this outbreak is where the kidney transplant kids (among others) stay.

I have always been pretty good about washing my hands at the hospital. I was quite proud of myself for going through all of clerkship without picking up any nasty bugs. But this outbreak has given me (and I think a lot of the other staff as well) considerable pause. While many of us might have previously been inclined to work through illnesses or gripe about how long it takes to "gown up", everyone is reaching for the hand sanitizer after and before every patient now. It is great that everyone is taking infection control more seriously now, and it will definitely decrease passing infection between patients.

There are already 5 residents off on sick leave. They will all be gone for at least 5 days to prevent spreading infection to any other patients (so far there are only two confirmed infected patients). This is creating havoc with the call schedules. I think the chief residents have doubled their grey hairs in the past week.

It also makes me think of Harold. I am now responsible to stay healthy to take care of him as well as to prevent passing a bug along to my patients.

But H1N1 is now a community acquired infection. Many of the kids I see in emergency (my present placement) most likely have it. We don't even considering testing for it unless the patient has to come into hospital. Most people with the infection aren't even being seen by doctors.

Now that Harold is in daycare he has a good chance of picking it up regardless of what I do. And if he does, I am probably not far behind. The only up side would be that I no longer have to feel bad about staying home when I am sick.

What do you think?

I haven't posted in awhile for all the regular reasons (too much in the to-do list and the regular cadre of everyday stuff getting in the way). But I have also been struggling over what I should be concentrating on in this blog.

Now that I am a doctor and all official like, I am somewhat reluctant to post about medical stories. Pediatric neurology is a very small specialty and there is no way to make these stories completely anonymous. To protect myself and the little ones that I am lucky enough to take care of, I don't want to expose them to the whims and harsh stares of the internet.

Then there is being a mother. Harold is a huge part of my life and is continually surprising me, mostly with normal progression of babydom. I could use this blog to tell little stories about how pleased, but also scared I am now that he is standing and able to reach a whole new world of mischief. While all of that gives me endless pleasure, I don't really think it is worth your or my time to dwell on so much navel gazing.

I could use this blog to broadcast all my ranks, displeasures and pet peeves. But usually, by the time I have a spare moment to write something I have either forgotten or no longer have the rage fueled energy to post about the jerk in traffic or how stupid the government's latest move to "improve" healthcare is.

So what do you think? What would you like to read about?

Long time coming

A lot has happened since I last posted. Not surprising since it has been such a long time.

I am now two days away from being done medical school.

I anticipated that these past 8 weeks (my make-up time for the "maternity leave" I took in the fall) would feel long, and they certainly haven't disappointed in that regard. I had my obstetrics and gynecology rotation first. It had been shortened from 6 weeks to 4 for the new class (or which I am temporarily a member). Unfortunately the director had been quite disappointed that the rotation had been shortened and wanted to make sure that we had as much experience in the 4 weeks that clerks had previously spread over the 6. This made for a particularly grueling rotation with lots of long hours and no time for studying. Bad enough if all you are trying to study for is the rotation test but even more frustrating for me trying to study for my licensing exam. At least they were kind enough to let me take the day off to write the test. (I still don't know my results, the dread of which still haunts me.)

I am not usually a huge complainer. I (at least in my own conception of myself) usually just go about getting done what needs to be done and don't whine. But there was a point in April while all of my classmates were sleeping in, sitting on their asses studying and complaining on facebook about being bored and I was doing crazy busy call, taking care of Harold whenever I was home and trying to sneak the odd cramming in that I was about ready to start my own pirate radio station just to bitch. "You think you're tired !?! Let me tell you"

Well I got through that. Then the next rotation was cardiology, busy but no call and I was usually home at a reasonable hour. But then there was graduation. I had fun at the graduation dinner but the whole thing was a bit depressing. Everyone was referring to themselves as "Dr". Aside from just finishing another day of my medical student rotation, I was reminded in a bunch of ways that I was not really a member of the group. No gown or hat for me. I didn't get fancy graduation pen with my name on it. My actual convocation will be small, with people I don't know - I might not even bother to go if I have to take time off of work.

Right now I am on an elective in my chosen field. It is kind of nice to get a bit of a relaxed intro to residency. I am still a medical student with no real responsibility but I am getting to know people in the program better and sort some of the paperwork and details out. The only problem is that I am completely burnt out and just counting the days and hours until vacation. I would like to be all keen and engaged but I can barely focus during a conversation. Not the best impression to start with.

In other news, Harold is doing really well. But that update will wait for another post.

Settling In and Strained Peas

I am starting to get used to the idea of residency and the idea that I will be a doctor with little munchkins under my care. And I am also getting really excited about it. Clerkship has been great but there have definitely been parts that were greater than others. Moving to more and more experience that is relevant to my chosen vocation is welcome.

In the meantime I have 11 weeks of clerkship to finish. The rest of my class has 3. 8 weeks is not very long for a maternity leave but right now, with the rest of my class making plans for their 2 months off and having abundant time to study for their licensing exam, it seems interminably long. Not to mention that spring keeps threatening to emerge (not this weekend, this weekend it snowed 10cm) and mock me as I am trapped in the hospital.

I am just going to have to swear off facebook, put my head down and plow through. And ask for the evening off to go to my graduation dinner.

In other news we have started the little guy on food. So far he has tried rice cereal, butternut squash, carrots, yams and honeydew melon. The melon is by far his favorite but most things go down pretty good. Each weekend I have cooked and froze (as directed here) vegetables to eat through the week. I was thinking again today how having a kid changes your life in a million little ways you don't think of. I never would have thought "strain peas" would be on my to-do list.

Today was match day.....

And I got my first choice.

Which mostly has me scared out of my mind

But when it came to ranking I had to go with my heart. I am still scared out of my mind but I have 4 months to get used to the idea.

And we will be staying put, close to friends and families and our favourite restaurants. A small part of me is sorry that we will not be heading out somewhere new, somewhere adventurous, but I am confident that this is was the best decision for us. Anything to avoid a move :)

Decision Making

Today was the day that our rank lists were due. I had arrived at a list I was fairly confident in about a week ago. Yesterday I started having doubts but, after gazing at it, I made only minor changes and went to bed happy.

This morning I had more doubts. Basically I have been deciding between two specialties. One that is more narrow and I have less experience in. The experience I did have was some of my favorite parts of clerkship but it is hard to know how representative those three weeks were. The other is more broad and I have done enough time to know that I would be happy there.

Then there is location. All the programs I interviewed at are reasonable so it comes down to where we want to live.

The deadline is passed and now I just have to wait and live with the result. I know that I would be happy in any of the programs and either specialty. So why I am stressed now? I have always been happy with the gut decisions I have made in the past and I have no reason to think this will be different. I think what is bothering me is the uncertainty. Once it is over, whatever the result is, I will be happier. Just a week and a half before this theory is tested.

Touring

Bad Blogger, bad blogger.

I really have meant to stay more in touch. And I can't say that I have had nothing to talk about.

I have recently completed the CaRMS tour, a whirl wind trip around the country to interview for residency spots for those not familiar with this particular circus. I traveled from St John's Newfoundland to Vancouver BC and many spots in between; including 10 flights, a car trip, many random bed and breakfasts, hostels and couches. It was hard being away from Harold for such long periods but my mother-in-law came to help take the strain off the Hubby and everything went really well.

It was a surreal experience seeing so much of this gigantic country in such a short period, often spending less than a day in many new places. I hope to go back to many of them, but I don't think I would pick January/February. We heard "it usually isn't this cold" at almost every stop (not Vancouver of course, there were bike riders wearing t-shirts). I remain incredulous.

Now the task of trying to decide our futures. I have to rank the different programs. I applied to more than one discipline; neurology and pediatric neurology. Not really that different I know but it adds another level to the decision making. I think I have mostly arrived at a decision but I will share more about that after match day (March 9th). I don't want to upset the matching gods and inadvertently jinx myself.

In the meantime I finished surgery (though not the exam, I was in Toronto that day). The next two weeks will be Emergency and then Family. I am starting to feel a little left behind with my classmates already on the home stretch. Many of them will be on their last rotation and are focusing on the liscencing exam or vacation planning. I know the 8 weeks that I have to make up is not really very long, but I think it will feel pretty long when all my classmates have already flown the coop.*Don't worry, he is well within arms reach of my husband.

Adventures in boob land

With a whole month between posts you might think I would have more to talk about (Christmas, school, momming) but things are pretty routine. Desperately trying to keep my head above water, but routine.

This post from a newly discovered blog has inspired me to post again. My little guy is now approaching 4 months and has been exclusively breast fed so far. This is the ideal that is promoted at every pre-natal, post-natal, vaccination, lecture, bus stop ad and match book cover (or at least that is the way it seems). Despite it being the natural option it is certainly not as easy as it might look. Child birth is "natural" too and that was no walk in the park either so I am not really surprised.

Things have been going pretty well for me and the little guy. I have friends who have not been able to keep it up nearly as long for a variety of reasons. While on leave I managed a modest stock of frozen baggies and have pumped (usually) twice a day now that I have returned to the hospital. Being a medical student with absolutely no control over my time, pumping usually means stealing 15 minutes away crouched on a toilet eating with one hand and trying to hold two pumping funnels on with the other. If this doesn't evoke a mental picture I will just tell you, it is not fun.

Sometimes I find an unoccupied call room where my pump and I can have a little more comfortable alone time. Which has probably led most of the cleaning staff to think I am having some kind of elicit midday affair ala "Grey's Anatomy".

After a few weeks of this my supply started to drop off. Combined with a growth spurt this made for a couple frustrating days for the boy and ate up all of our frozen reserve. My doctor put me on Domperidone - a gut motility agent that has raised prolactin as a side effect; or a prolactin raiser with diarrhea and gut cramps as a side effect. Holding a scope for a lap chole while your small intestine spams is also... not fun. But it worked and we are back to pumping enough to fatten the little guy up.

These problems are minor but med school and mothering are already pretty challenging undertakings and I am starting to resent the extra effort. For now I will keep at it but I can sympathize with all the other mothers out there that have sped the transition to formula or solids.

Happy New Year

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.