Table for One

Vacation Recap - Falmouth, Jamaica

2012-03-08T16:00:00.002-06:00

Over the next few days, as time permits, I'm going to write posts about the different places that my Mom and I visited on our cruise and about the city of New Orleans (the latter may require more than one post). Our first cruise destination was Falmouth, Jamaica, which we visited on day three of our cruise. Falmouth has just recently been established as a cruise ship port by Royal Caribbean, and the port shops that sell duty free liquor and "Jamaican" souvenirs still have that brand new building feel.

The Falmouth port from our ship:

The town of Falmouth, on the other hand, was a prosperous shipping port during the late 1700s and early 1800s*, but is now very impoverished and rundown. Most of the historical buildings that were described as "tourist attractions" in the cruise brochure are in fact quite badly decayed and in need of significant repair work.

One of the historical buildings adjacent to the port, with renovations underway:

One of the rundown houses that were common in Falmouth:

Given that this was our first cruise, my Mom and I decided to participate in planned excursions rather than trying to venture off on our own at the ports. In Falmouth, we went on an excursion that took us first to the Rose Hall Plantation and then to Doctor's Cave beach for some relaxation. The plantation was beautiful, and we had an outstanding tour guide who brought to life the history of the slaves who worked the plantation and the masters who ran it. It was a great site to visit, although unsettling to think of the history behind it.

The front of Rose Hall:

A view of the grounds of Rose Hall from inside:

After visiting the plantation, we headed to the city of Montego Bay, where we were supposed to have a tour of the city and of Sam Sharpe Square, neither of which happened. Instead, we were all herded inside a souvenir shop, where we were forced to spend 20 minutes looking at "Jamaica" t-shirts and baseball caps with fake dreadlocks hanging from them. To say that my Mom and I were unimpressed would be an understatement. After the forced shopping, we were taken to Doctor's Cave beach, which is a small, private beach inside the city. I was still feeling a bit crotchety from our unexpected shopping excursion, but even I can be won over by the crystal clear waters of the Caribbean. Ahhh.

There was also jerk pork (shown here) and chicken (my Mom's lunch, not shown) to appease me:

Following our stop on the beach, we headed back to Falmouth, where we had a few hours to explore on our own before getting back on the ship. Immediately beyond the port area were streets filled with stalls, where the vendors called out to us to try to get us to buy more mass-produced souvenirs.

I suspect my Mom would've been happy to stop at that point, but I have an irrational love for old, decaying buildings, so I forced her to go further into the town to see what else was there. Using a historical map, we found our way to a few of the historical buildings, which were in varying states of disrepair.

I had expected to find the town filled with tourists from the cruise ship, but in our time outside of the port shops I saw only two other people who didn't look like locals. Unfortunately, this meant that we attracted a lot of attention from the inhabitants of Falmouth, and we were constantly shadowed by schoolkids who wanted us to take their pictures or who wanted to guide us through the town in exchange for money. While I've dealt with this kind of attention in other places (Havana, Cuba being the first the comes to mind), this was the first time that it's happened when I haven't been surrounded by throngs of other tourists, and I actually felt pretty uncomfortable. My Mom was downright petrified, so we headed back to the ship before I'd gotten my fill of taking pictures. (If it's ever possible for me to get my fill of taking pictures.)

All in all, our visit to Falmouth was okay, although I was disappointed that we didn't get to see more on our excursion or of the town itself. I wish that I knew someone who lived in Jamaica, as I would love to see more of the country from a local's eye.

* A brochure on Falmouth that was handed out to the cruise ship passengers describes the period from 1780 to 1830 as Jamaica's "golden age", despite the fact that the country's economic prosperity was based on a sugar industry that was dependent on slave labour. Can we please, as a society, agree to never refer to a period of time in which human beings were tortured and enslaved as a "golden age"?

Dammit

2012-03-07T20:50:00.000-06:00

I was just about to start writing about how happy I was to be coming back to a relatively relaxing rotation (i.e. research), when my phone rang and my call display showed the chief resident's name. A phone call from the chief resident is never a good thing, and this was no exception. Apparently one of the residents who is on night float for the next two weeks is seriously ill, and I'm therefore being pulled from research to cover night float for the next two nights. And possibly for the next two weeks if the resident doesn't get better or another alternative isn't identified.

(/insert sound of Solitary Diner screaming and flinging things against the walls)

I'm trying to not be upset about this, but I was really, really looking forward to a slower second half of the year. Despite being away for two weeks, I still fell tired and burnt out - and two weeks of continuous nights isn't going to help with that. I've also been stockpiling a to-do list for when things "quiet down" a bit, and clearly that isn't going to happen now.

(/insert sound of Solitary Diner weeping)

Oh well. There's absolutely nothing I can do about it, so I'm going to try to limit my whining and moaning. Starting tomorrow. Looks like my plans to start running this month are going to be somewhat delayed.

A happier post recounting my visit to Falmouth, Jamaica to come tomorrow.

March Goals - Hitting the Pavement

2012-03-06T10:23:00.000-06:00

I'm home! After 10 hours of taxis, airplanes, and waiting in Canadian Customs lines, I arrived home late last night to a city buried under snow. Just what I was hoping for. It's somewhat of a shock to the system to go from basking in the sun in New Orleans to bundling up in a parka in Canada. Thankfully Spring is only 16 days away (C'mon nice weather!).

Thanks to my paucity of internet access while away, I have a backlog of stories and photos to share from my trip, but given that it's the "start" of the month, I thought I'd take a brief hiatus from talking about vacation to write a post about my monthly goals. Looking back over the past four months, I haven't done particularly well with my goals. My November goal to plan my meals on a weekly basis was definitely my most successful, but even it got abandoned a few weeks ago as life got busy and emotionally challenging. My December goal to reduce my internet and tv habits never really got started, mostly because it was more stressful than it was worth to actually track how much time I was spending on those activities. In January, I ambitiously set two goals: getting enough sleep and cutting back on the "extras" in my diet. The first goal I've stuck with for the most part (as much as 1 in 3 ICU call will allow), but the second I eliminated very quickly after it started making me unpleasantly food obsessed. I did manage to achieve most of my February goals related to work, but that was mainly because I set pretty easy goals for myself, like finishing a mandatory presentation and mandatory readings. That isn't so much an accomplishment as it is being a responsible adult. All in all, my adherence to my monthly goals has been variable, but I have definitely made some progress.

Which brings me to March. Before I started medical school, I was a somewhat dedicated distance runner, and I'd even worked myself up to the point of being able to run a half marathon. (Sadly, I never formally completed a half marathon thanks to a bad sprain, but I have run the distance in training.) Despite being the kid who was always picked last in gym class, I really enjoyed running as an adult, and it was a great form of relaxation and stress relief for me. I had expected to keep it up in medical school, but unhappiness and busy schedules and bad running conditions (I was living in a not-so-safe part of downtown) all contributed to me dropping the habit. And I've missed it. I'm exceedingly jealous of the people I see running along my city's tree-lined streets while I'm stuck in my car in rush hour traffic, and I'm sick of being so out of shape that I get winded walking up stairs. I miss being a runner, and I want to be one again.

The conditions in my life right now are about as perfect as they will ever be for getting back into running. I've moved into a new apartment, which is located in a more residential area with easy access to miles of quiet and safe side streets with large sidewalks. Spring is almost here, which means that the outside running conditions are going to get progressively better for the next six months or so. And for days when it's too cold/wet/otherwise unpleasant to run outside, I have a gym in the basement of my apartment building. I really can't beat that for accessibility. As well, I'm on a research block for the next four weeks, which means very regular and flexible work days. And no call. None. For four weeks. (/dance of joy) Clearly, I will have both the time and the opportunity to get back into running; the only thing I need to provide is the motivation.

Over the next month, I'm committing to running three times a week. The runs will likely be slow and short, but that's where my poor, out of shape self needs to start. I'm going to post running updates on the blog as a way of tracking my progress and holding myself accountable, because this is really something I want to do. Please feel free to leave nasty comments if I'm not posting running updates. (Which won't happen, because I'm going to stick to this goal. Period.) I'm also committing to getting back to regular meal planning this month. I feel so much better (and waste so much less money on takeout) when I'm cooking on a regular basis, so it's a habit I need to resume.

March should be a good month.

Lessons from Bourbon Street

2012-03-05T00:17:00.001-06:00

1) Bourbon Street at night is, at first glance, a horribly unpleasant shrine to all manner of human depravity.
2) If you can tolerate walking a few blocks down Bourbon Street, it is possible to find a club where the patrons are (mostly) sober and there is a live band playing amazing jazz.
3) Said club will happily let you listen to said live band; however, they will make you buy one drink for every set of music that you listen to.
4) Each set is short, and there are many sets.
5) American drinks contain vastly larger quantities of alcohol than Canadian drinks.
6) Any drink made from flavoured slush will go down very easily, regardless of the alcohol content.
7) The effect of large quantities of alcohol* does not become fully apparent until one tries to get up to go to the restroom and suddenly finds oneself lying horizontally on the floor of the club.
8) After drinking on Bourbon Street, it is very helpful to have one's loving and responsible mother along to drag one back to the hotel and force water and Advil down one's throat.

Thank goodness I head back to Canada tomorrow, where slushy drinks contain so little alcohol that one will go into a hyperosmolar hyperglycemic state long before one will get intoxicated.

Back to my regularly scheduled blogging (including updates on my cruise ports and my final days in New Orleans) once I return home.

* Lest you think I'm a lush, "large quantities of alcohol" refers to two drinks over an almost three hour period of time. I am, in fact, a lightweight. Who unwisely went to the club before supper.

Cruise in Review

2012-03-02T10:29:00.000-06:00

Today, sadly, is my last day on the cruise. To make the most of it, I’m currently sitting on the sunny deck, gazing at the ocean and listening to the funny Southern accents* of my fellow cruisers, while enjoying second breakfast. Because if you’re only eating three meals a day on a cruise, you’re wasting precious opportunities to maximize your caloric intake.

After a week on a cruise ship, I can definitely understand the appeal of this kind of vacation. It’s hard to get more relaxing than a vacation where your every need is taken care of, and you can have virtually every material desire satisfied by just handing over your SeaPass card. (Of course, the SeaPass card is linked to one’s credit card, so one shouldn’t get in the habit of handing it over too much, unless one likes the thought of spending the rest of the year paying off a one-week vacation.) It’s been wonderful to be completely free of obligations and stress for an entire week, and to have nothing more strenuous to do than walk from the cruise ship to an air conditioned tour bus. The chaos of the ICU feels blissfully far away right now.

But – there’s always a but with me – this isn’t my kind of vacation. When I travel, I want to see and experience a place, and that just isn’t possible when you have only nine hours at each port. We picked our excursions to try to see as much of the countries as possible, but we still got only brief glimpses of the places we were visiting, and they were very insulated and sanitized glimpses at best. There was no wandering lost through areas of questionable safety or fumbling to communicate in a foreign language or risking food poisoning by eating unidentified meat from a street vendor. Every tour was contrived and controlled to present a specific image of the place we were visiting, whether or not that image bore any resemblance to the reality of the place.

What has stunned me a bit about cruising is how many of my fellow travelers actually want this kind of travel experience. Many of the people I’ve met don’t want to have an authentic experience of the countries they’re visiting, but rather want to simply transport American culture to different locals with better weather. A significant percentage of the people on my ship spent their days in port shopping in the cruise ship-operated shopping areas or sitting in American chain restaurants drinking overpriced margaritas. And some people didn’t even get off the boat. While I understand that there are some people who are simply too tired (e.g. parents with young kids) or too physically limited to get out and explore the countries they’re visiting, I can’t understand how a healthy, childless person in their twenties or thirties could spend hundreds of dollars to travel to foreign countries and then spend their time drinking in Senior Frogs. It just doesn’t make sense to me.

(Whew. I feel much better now that I’ve gotten that off my chest. Thank you for indulging my feelings of moral superiority for a moment. If you enjoyed that rant, I can also tell you about how I’ve overcome America’s obsession with body image while I’m enjoying pre-lunch.)

In the end, even though I won’t likely go on a cruise again, I’ve had a very good week. I’ve relaxed enough to return my blood pressure to the normal range, I’ve replenished my fat stores for the rest of the long Canadian winter, and I’ve scoped out some good locations for future tropical vacations. (For example, I could happily spend a week drinking margaritas at the tiny beach in Cozumel we visited yesterday, authentic cultural experience be damned.) And I still have two days to cram in as much of New Orleans as possible, so life is good.

* No offense to anyone reading this who has a Southern accent, but to my Canadian ears y’all just sound so strange. Of course, I’m sure I sound just as odd to the people from the South as they do to me.

** In case you’re wondering, I have not spent hundreds of dollars on internet to write this rather verbose post. I’m composing it in Word and then cutting and pasting it into Blogger. If you’d like to send donations to cover my internet costs anyway, I’d still be more than happy to accept.

Wish You Were Here

2012-03-01T21:08:00.000-06:00

Blogging, Cruise Style

2012-02-27T20:48:00.007-06:00

Did you know that Wi-Fi is ridiculously expensive on a cruise ship?

Did you know that I'm addicted enough to the internet to pay ridiculously high prices to use it on a cruise ship?

I've been in internet withdrawal for the past few days, partly because of the cost and partly because my Mom is with me every waking minute of every day. My Mom has finally headed off to a bar, leaving me with a few precious minutes of quiet time, so I'm getting caught up a bit on the online world. I love my Mom...but I really don't need to be with her 24 hours a day.

So that this doesn't bankrupt me, I'll just give a quick overview of my first 48 hours on the cruise ship. All of the time has been spent at sea so far, with our first port stop in Falmouth, Jamaica tomorrow morning. I'm excited to be getting off the ship and exploring the outside world again, as my camera has been feeling a bit bored since coming on the cruise.

The Good:

1) Food: We have a formal dining room, a cafeteria-style area, a 24-hour-a-day cafe, and room service, all of which serve very tasty food. I have never been so continuously stuffed in my entire life. I had to skip an entree at supper tonight, because there just wasn't another inch of space in my stomach.

2) Sleep: I slept nine hours last night, and then had a mid-afternoon nap today. It feels fabulous.

3) Reading: I really have no interest in the casino, Bingo games, shopping seminars, evening shows, or other forms of entertainment on the ship, but two almost uninterrupted days to lounge around with a book? Heaven! I've finished the Hunger Games (Why didn't I buy the sequels too?) and am approaching the end of My Life in Paris, and I'm loving it.

4) The Balcony: My Mom convinced me to splurge on a room with a balcony, and although I thought it was a waste, I'm so glad we did. It's been lovely to sit in a deck chair, basking in the sun and watching the ocean go by. And the fact that it's a private space helps me deal with not-as-good item #2.

The Not-as-Good:

1) My poor math skills: Somehow, early in our trip planning process, my Mom and I got the idea in our heads that our cruise ends on Friday. We planned everything around this notion – hotel bookings, flights home, list of things to do in New Orleans – and it wasn’t until we got on the cruise and looked closely at our cruise itinerary that we realized that our cruise actually ends on Saturday. (/insert sound of palm hitting forehead) Suddenly my three short days in New Orleans have been reduced to two short days in New Orleans, and I’m forced to cull even more items from my already condensed list of New Orleans activities. Needless to say, I’m just a wee bit annoyed with myself for not being able to read a calendar correctly.

2) People: There are people everywhere - in the restaurants, in the shops, in the pools, in the elevators - and it's more than my introverted self can handle. I'm so thankful to have our own private space to retreat to when I get tired of being around others. Which is often.

Anyway...tomorrow is Jamaica day! I'm excited about dusting off my camera and getting some shots of historical Falmouth, although they won't likely get posted until I'm off the boat given that I'm not made of money.

Arrival

2012-02-24T20:46:00.003-06:00

You know how sometimes you dream about a place before you visit it, and then when you get there it just doesn't live up to your expectations?

New Orleans is not one of those places. I've only been here for four hours, and I'm already in love with it. The tree-lined streets, the Georgian architecture, the jazz playing everywhere, and the food (the FOOD!) - this is my kind of city. I'm actually sad to be going on my cruise tomorrow, as it means I have to leave New Orleans when I've just barely started to explore it. (Yes, my life is hard. I'm sad about going on a cruise. I'm sure you all feel tremendous pity for me.)

Here are some highlights from day one. (It's quite overcast here, so my apologies for the rather dull photos.)

The Garden District on our way to dinner:

The utterly amazing Upperline Restaurant, where I had my first introduction to New Orleans cuisine:

The fabulous interior of the restaurant:

Dinner! I started with fried green tomatoes with shrimp remoulade.

Then had sauteed shrimp with crispy grits. (Mmmmmm...grits....)

Then finished with bread pudding.

If I continue with this pattern throughout my trip, I may be too large to lift myself out of my deck chair by the end of the cruise. Which I suppose I can live with. Because this food is absolutely amazing, and worth every calorie. Mmmmmm.

To Do List - Tropical Vacation Version

2012-02-23T23:33:00.000-06:00

I should be sleeping, given that I need to wake up in four hours to catch a plane, but it's still early and I'm not feeling even remotely tired. So I thought I'd write a list of things that I want to do while on my trip. I did a similar thing before my trip to the Rockies last year, and it was a fun way for me to reflect back on the vacation afterwards and see how close it had come to my expectations. My trip this time is going to be very different from my previous one, given that I'm traveling with my Mom and have a more planned out schedule than I did last time, but hopefully it'll be just as enjoyable.

So here's my list:

1) Satisfy my inner geek.

When traveling through Italy two years ago, I discovered that many of the cities have anatomy or zoology museums that are hundreds of years old and that are open to the public. I absolutely loved these museums, and ever since I've sought out similar museums when I've traveled to other cities. I couldn't find an anatomy museum in New Orleans, but I did find a Pharmacy Museum that definitely appeals to my geeky side.

2) Relax with a book.

The last time I traveled, I couldn't tear myself away from the mountains long enough to sit down and read a book, but I'm hoping to find time to do it on this trip. I've had the Hunger Games sitting on my bedside table for almost a year, so hopefully I'll be able to get through it on one of our days at sea. A (very overpriced) margarita may help.

3) Turtles!

As I've mentioned many times, I have an odd fascination with sea turtles, so I'm very excited about going here. I'll probably devote an entire blog post to my visit to the turtle farm. (I'm sure you can't wait to read it.)

4) Sleep.

Work has taken a lot out of me lately, and so as much as I want to see and do everything on my trip, I also want to slow down and spend some quality time in bed. My cats will serve as a good example for this one.

5) Spend some quality time with my Ma.

I've written before about how my Mom and I butt heads sometimes. I love her dearly, but we don't always see eye to eye on the world, and we often want to do very different things with our time. I'm hoping that getting away from all of the regular life stresses will give us some time to connect and work past some of our differences. If not, we've already pre-booked our wine package, so we should be good.

6) Practice good skin hygiene.

If I ever go missing and need to be described to the police, a list of the risk factors for melanoma would be a pretty good start. Fair skin, light eyes, freckles, and burns easily? Yep, that's me. So I won't be lying in a deck chair until I turn bronze, but rather will be slathering myself up with SPF 55 and wearing a hat. If you happen to be wandering around the cruise ship port in New Orleans on March 2, I'll be the only one who is still completely lacking any skin pigment.

7) Take a ghost tour.

I've been on ghost tours in Edinburgh and Calgary, and I find them to be an interesting way of learning about the history of an area. I'm not one for memorizing dates from a textbook, but I do enjoy hearing stories about grizzly murders and about entire stretches of cities that have been wiped out by plague. (Further proof that I'm a wee bit odd.)

8) Listen to jazz.

The airport in New Orleans is named after a jazz great. How can I not listen to jazz while I'm there?

9) Prepare for the end of the world.

Just in case the world comes to an end this year, I'd like to first see the remains of the civilization that predicted it. Thanks to the suggestions left in the comments, we've decided against making the long (and potentially seasickness-inducing) trip to Tulum, and will instead be taking in the San Gervasio ruins that are much closer to our port. I have my camera ready!

10) EAT!

I hear rumours that there's some good food in New Orleans. Erin of the White Coat Files quite kindly provided a list of good places to eat in response to one of my earlier posts, so between her list and Trip Advisor I think we should be well-equipped to find some good restaurants. My list of things that I want to eat while in New Orleans includes, but is not limited to:

crawfish

beignets

po'boys

jambalaya

mac and cheese (and not the boxed kind)

fried green tomatoes

collard greens (I haven't the foggiest clue what they are, but they sound Southern to me)

pralines

bananas foster

gumbo

I will not, however, be partaking of cooked turtle in any way, shape, or form. Or oysters. I like to think of myself as open-minded when it comes to food but 1) turtles are not food in my world and 2) the first (and only) time I tried an oyster my stomach absolutely refused to allow it entrance. And gagging in a restaurant is not my idea of fun.

Ahhhh....sounds like eleven fabulous days. I can hardly wait! And I don't have to much longer, given that my flight leaves in six hours. Sigh. Time to get a few short hours of shut eye.

Technical Support

2012-02-23T14:38:00.000-06:00

Do you know what happens when you leave most of your travel preparations until the last minute, and then you go out with a friend for tapas and G+Ts when you should be packing?

PANIC.

I was actually doing okay with my last-minute, frenetic preparations this morning, but then I hit a snag in the form of my iPhone. Previously, when I've downloaded music from my good old-fashioned CDs to iTunes on my computer, I've been able to synch all of the downloaded music to my iPhone by hitting the synch button. Today, not so much. As far as I can tell, since Apple's introduction of the mysterious iCloud, I've either lost the ability to synch downloaded music to my iPhone, or the method for doing so has been buried deeply in the inner workings of my computer.

This really isn't a big deal. I'm still leaving for New Orleans tomorrow, and I'll still be getting on a cruise in about 48 hours time, so this is really nothing more than a minor annoyance. But I'm frustrated because I bought a few new CDs specifically for this trip (go $5/$10 bargain bin), and now there doesn't seem to be a way to get them onto my iPhone. Given that I'm spending 11 days straight with my Mom, music may be a very essential way of maintaining my sanity.

Anyone out there ever encountered this and figured out a solution?

Nutrition Math

2012-02-20T10:00:00.003-06:00

Diet Pepsi cancels Bac'N Puffs.

(Surreptitiously photographed while buying groceries yesterday.)

Forward Gazing

2012-02-19T12:26:00.000-06:00

Medicine changes people. For me, the change has been mainly positive: since starting medical school, I've become much more outgoing, my confidence in my abilities has increased, and I've become far more appreciative of all the things I have in my life. All in all, I'm a much happier person than I was before starting medicine, and I'm forever thankful that I got up the courage to go back to school.

Lately, however, I've started noticing a negative change occurring. It's been so slow and insidious as to be almost undetectable, but it's there. Specifically, all of the tragedy and unexpected deaths that I've witnessed through my work have made me terrified about my own future. Despite it being statistically unlikely that I'll die anytime soon, I've internalized this deep fear that something terrible and sudden is going to happen to me.

This usually isn't a conscious thought, but rather something subtle that sneaks into my thought patterns over and over again. When making dinner plans with friends, I'll suggest that we go somewhere nice because "You never know how many more meals you're going to have." Or when planning my upcoming trip, I've said to my Mom numerous times "We should just splurge. This may be the only time in our lives that we go to New Orleans/Jamaica/the Cayman Islands/Mexico." The undercurrent of uncertainty that pervades my thoughts drives me to fit as much experience and happiness as possible into every moment, regardless of the long-term cost.

While it's important to not always defer one's happiness, my obsessive focus on the here and now isn't good either. I find myself often unmotivated to study or exercise or do anything else forward-thinking because it will all be a waste of effort if something bad happens to me in the near future. Which is clearly not a good thing, because if I do live long enough to finish my residency and reach middle age, I'm going to be a pretty miserable person if I haven't learned enough to pass my Royal College exam or if I'm so out of shape that I get winded walking to my car. Once again, it's all about balance, and unfortunately my balance is shifted too far towards the short-term, hedonistic side at the moment.

I'm hopeful that this negativity is transient, the result of too much immersion in Palliative Care and ICU, and that I'll go back to my generally optimistic outlook after a few weeks away from work. But in case it isn't, I'd be open to any suggestions people may have on how to keep medicine from destroying hope.

Numbers

2012-02-18T10:54:00.000-06:00

7 - Days until I leave on my Caribbean cruise

6 - Days until I leave for New Orleans

5 - Days until I'm on vacation

4 - More sleeps until my last day of work

3 - Days left of work in the ICU

2 - Days off this weekend to catch up on rest

1 - More terrifying ICU call shift

(Photo from Are You Gonna Eat That?)

I don't need this vacation nearly as desperately as I needed my last vacation, but I'm definitely ready for my six-week Carnival of Death (i.e. consecutive Palliative Care and ICU rotations) to be at an end. In the past five and a half weeks, I have been witness to so many deaths and so much grief that I'm finding it hard to remember that there is joy and happiness in the world. Hopefully seven days of lounging on a 15-storey cruise ship eating complimentary room service will be enough to bring me back to a place of optimism and hope.

And if the cruise doesn't do it, there's always turtles.

(Have I ever mentioned how much I love turtles? I'm ditching my Mom (who is going snorkeling) on Grand Cayman so that I can visit the turtle farm. They bring me such inexplicable joy and delight that I couldn't miss it.)

How to Make your Cats Happy for $20

2012-02-16T12:21:00.001-06:00

While on call last night, I had an unheard of 7 hours of uninterrupted sleep, so I'm feeling fabulous this morning. I know that I still need to sleep (on-call sleep is in no way equivalent to at-home sleep), but I can't quite pull myself away from the computer and all the other fun things that exist outside of the ICU just yet. So here I am, posting for the first time in four days. I've missed the blog!

Driving home today, I stopped at my local pet store to pick up some kitty necessities, and in typical post-call delirium I was enticed by many things that I don't actually need. When I'm post-call, all of these unnecessary things become "OMG-must-have-this-now" items in my mind, which is why I must never be allowed in a jewellery/computer/automobile store on a post-call day. The one item that I absolutely couldn't resist today was a cardboard scratching post.

My cats have been doing a lot of scratching of inappropriate things lately (carpet, beds, backpacks, couches), so I thought the cardboard scratching post would be a good alternative to things that I don't actually want destroyed. It even came with catnip to supposedly entice the cats to scratch it.

Unfortunately, all my cats wanted to do is eat the cat nip.

After about fifteen minutes of licking the catnip and rubbing themselves against the scratching post, they discovered that there was a hanging toy on a string inside.

When you're high on catnip, nothing is as exciting as a toy on a string.

The scratching post itself presented a barrier to accessing the toy, but my cats were not to be deterred. Thus the scratching post was disassembled. Much more exciting this way!

While Callie enjoyed her much improved access to the toy, Hobbes took advantage of the newly freed scratching part of the contraption, and began cuddling affectionately with it*.

Hobbes, blissed out on catnip, enjoying his new friend.

The cats have yet to make even the slightest gesture resembling scratching towards the scratching post, but they are definitely happy. While it may never become an alternative scratching target, hopefully it will at least remain interesting enough to distract them from all of the tempting items around them. If not, I'm never getting my damage deposit back when I leave this apartment.

And now, to bed I go... Back with more medically oriented posts when my 1-in-3 ICU call stretch is over.

*Yes, that is my Christmas tree still up on February 16. This is what happens when I spend my free time blogging and watching Top Chef Texas instead of tackling my to-do list.

Perspective

2012-02-12T19:52:00.001-06:00

I've been in a very whiney mood lately, in an "I'm tired and I don't want to do overnight ICU call and I just want to be on vacation already" kinda way. But then tonight, while filling out another consult sheet and contemplating all the tasks between me and (hopefully) some sleep, I witnessed a young woman approaching death in the bed across from me. And suddenly was reminded of how unbelievably lucky I am.

ICU Blues

2012-02-10T22:47:00.001-06:00

My last day of palliative care was on Wednesday, and I'm now working at the opposite end of the medical spectrum in the ICU. The change between the two services has been one of the biggest mental shifts I've ever made in my training, and my brain is reeling from all of the details about ventilator settings and sedative infusions and vasopressor dosages that I'm suddenly expected to know. As horrible as it sounds, it was actually a relief today when one of my patients was transitioned to palliative care, as I finally had a clue what I was doing for the first time in two days.

As a medical student who wasn't expected to know anything and who had absolutely zero responsibility, I really enjoyed my ICU experiences. I loved the complexity of the patients, and my anal retentive side was thrilled by the hourly recording of every physiological parameter that is capable of being monitored. As a resident who is now expected to save people's lives, ICU is a terrifyingly awful miserable place. I spend my time willing my patients to not decompensate, as I feel utterly incapable of doing anything for them if they do. My heart races uncontrollably when a "Medical 25" (a prelude to a "Code Blue") is called overhead, as I know it's only a matter of time until the formal code is called and I have to go tearing through the halls towards an unknown crisis. I volunteered to see a consult today, and I was filled with utter panic when I arrived on the ward and it suddenly occurred to me that the poor unstable patient was dependent on me for his survival.

(Lest you think that the survival of all critically ill patients in my hospital is in the hands of one terrified second-year internal medicine resident, I will point out that there are numerous ICU doctors, nurses, respiratory therapists, and other people who are much more competent than me watching everything I do. It just feels like I'm personally responsible for everything that goes wrong with the critically ill patients.)

It's been a long time since I've had this feeling of utter incompetence, and I'd forgotten how horrible it is. I like to think that I'm making progress in my training, but then I'm faced with a new challenge that leaves me feeling like a third-year medical student setting foot on the wards for the first time. I long for a time in my life where I'll feel competent and on top of things, although this may be a pipe dream. Many attendings whom I've spoken with say that they're still plagued by self-doubt and uncertainty after years of practice. Great. Something to look forward to.

Once again, I haven't anything particularly profound with which to end my post. I know that things will get better by the end of my rotation, as they always do, and that I will survive this constant feeling of terror and despair. But I still hate it and find myself wishing away the next twelve days. I'm going to really deserve my vacation by the time it arrives.

February Goals - Focus

2012-02-07T22:18:00.001-06:00

I initially had very ambitious academic goals for the month of February. Unfortunately, as my holiday approaches, it becomes harder and harder to keep my mind in the present and out of daydreams about walking through the French Quarter with a beignet in one hand and a crawfish po-boy in the other. So instead of dooming myself to failure by setting the bar unattainably high, I'm focusing on a few much less ambitious and more readily achievable goals. For anyone who's interested, my goals for February are as follows:

1) Complete my academic half day presentation before my Sunday call shift so that I don't have to finish it post-call on Monday. (A very sane goal.)
2) Complete my mandatory readings before starting my ICU rotation on Thursday. (You know, because they're mandatory and all.)
3) Turn off all distracting technology (iPhone, tv, internet) while studying.
4) Make significant headway towards setting up my visiting electives.

I was going to make my last goal "Have all of my visiting electives arranged", but I realized that a large part of elective planning is frustratingly out of my control, so I'm going to focus on replying to emails on the day that I receive them and doing anything else humanly possible to move the process along.

And that's February. Only 16 days until I leave for New Orleans! It's both wonderful and terrifying that my trip is so close, as I have a seemingly endless list of tasks to complete before I go. Time to get some sleep so that I'll have the energy to tackle it.

Evidence that I'm Not a Sports Fan

2012-02-04T16:17:00.001-06:00

Friend: "Hey, are you watching the game tomorrow?"
Solitary Diner: "Nah. I'm not that into hockey."

(Friend looks at me like I've just grown an extra head.)

Photo Friday - The Outside World

2012-02-03T18:16:00.001-06:00

Thanks to high humidity and low temperatures, everything in my city has been covered in hoar frost for the past three days. It's so beautiful that I just had to get out and take some photos. Here's some of what I managed to capture in the five minutes or so between my arrival home and sunset.

Mindfulness Meditation

2012-02-02T17:50:00.000-06:00

I often compose blog posts in my head while walking between buildings at the hospital. The buildings are connected by miles of subterranean tunnels, and their relative solitude inspires reflection and deep thought. Today though, the act of translating my experiences into words felt too much like self torture, like inflicting myself with wounds already inflicted on me by the external world. So instead of thought, I focused on my footsteps, on the clicking of dress shoes echoing off concrete walls and underground pipes. I forced myself to exist in the moment, to leave my memories of patients and their stories back on the wards rather than inside my brain, playing in an endless repeat loop.

One of the things that I enjoy about my job is its persistence in my mind, the fact that it's stimulating enough to dominate my thoughts even when I'm not in the hospital. Any of my friends would tell you that conversations with me are filled with discussions about work and that I'm excited and animated when I speak of it. But some days I need to just forget for a bit. So for today I'm focusing on the sound I make moving from place to place, trusting that it will continue to be enough to carry me forward.

Weary

2012-02-01T20:09:00.000-06:00

One of the things that surprised me about palliative care in the beginning was how happy the team members seemed to be. Everyone on the service has been consistently cheerful, and the days have been filled with laughter and utterly inappropriate jokes that can only be appreciated by people who spend their days surrounded by death. The mood of the team has been almost enough to make me forget about the suffering that we deal with every day.

But today it got to me. Maybe it was the cumulative effect of three weeks of moving patients from the list of people we're following to our list of the deceased. Maybe it was finally changing my longest-standing patient from active treatment to palliation. Maybe it was being witness to a death, my first on the service, rather than simply hearing about it after the fact. Whatever the trigger, today was a day that left me feeling drained and world-weary.

I was reminded today of the attraction of actively treating patients, of the appeal of being involved with sustaining life. It's comforting to believe that if you merely pick the right therapy, or if medical science only develops the right new drug, that you can prevent anyone from dying. When I started medical school, that was what I naively believed - that if we could just throw enough time and money into research that we could cure all illnesses and somehow escape death. My work on palliative care is a constant reminder of life's finite nature, and some days it is just so inescapably sad.

So tonight I'm self-soothing, indulging in warm cardigans and cold chocolate ice cream and hot baths filled with smelly bubbles. Instead of devoting my evening to textbooks and spending time with friends in need, I'm immersing myself in the happiness and superficiality of Glee. Some at-home escapism to get me through the last three weeks before vacation. It's not the wisest way of spending my evening, but at the moment it's about all that I'm capable of.

Excited Beyond Belief

2012-01-31T22:53:00.001-06:00

About two years ago, my Mom and I decided that we should go someplace warm together. Normal people would make this decision, spend some time looking at resorts online, and then book a tropical getaway, usually within a few weeks of their first discussion about going someplace warm. Clearly, my Mom and I aren't normal. Over the past two years, we've had countless discussions about where we should go, all of which have ended with one or both of us rejecting the location under discussion because it was too expensive (Europe), too dangerous (Mexico), too likely to give us food poisoning (Dominican Republic), too boring (almost any resort), etc. etc.

The frequency and intensity of our discussions have escalated recently, as we decided to go away during my vacation that is just three weeks away (woo-hoo!), and until today we had nothing booked. In desperation to just DECIDE ON SOMETHING DAMMIT, I almost agreed to spend a week at an isolated all-inclusive resort, which was precisely the type of trip that I didn't want to do. (I hate lying on the beach. And I don't particularly like drinking. So I am clearly not a good resort person.) Fortunately, in a moment of inspiration, I came up with a solution that would combine my Mom's dream trip (go on a cruise) and my dream trip (being unleashed with my camera in New Orleans) all in one: go on a cruise that leaves from New Orleans.

(In retrospect, a smarter person would have figured this solution out a lot earlier.)

Thanks to this moment of inspiration, and three painful days spent searching online for cruises and flights and hotels that are both cheap and fabulous*, we now have our vacation planned. Four nights in New Orleans and seven nights on a cruise. I'm so excited about going to New Orleans I can hardly contain myself.

I want to go here:

This photo of the Garden District is courtesy of TripAdvisor

and here:

This photo of the St. Charles Streetcar is courtesy of TripAdvisor

and here:

This photo of New Orleans is courtesy of TripAdvisor

and here:

This photo of the New Orleans School of Cooking is courtesy of TripAdvisor

and here:

This photo of American Photo Safari is courtesy of TripAdvisor

Essentially just about everywhere in New Orleans. In four days. Totally doable, right?

* Anyone who has ever traveled to New Orleans will know that "cheap" and "fabulous" is really not a realistic combination in a New Orleans hotel room, particularly when one is booking only three weeks in advance of their travel date. Fortunately, I managed to find "not horrendously expensive" and "tolerably shabby" all in one. An acceptable compromise if it means that I can eat beignets and listen to jazz music and fill up my entire 16 GB memory card with photos. I am so, so, so excited.

Too Good Not to Share

2012-01-31T06:52:00.001-06:00

This is for anyone who grew up in the 80s and loved Ferris Bueller's Day Off as much as I did. Love this!

I still don't like gas-guzzling SUVs, but it's an awesome commercial.

Good Idea Gone Bad - January Goals Part Two

2012-01-30T18:06:00.000-06:00

It's almost February, which seems like the perfect time to be writing about my second goal for the month of January. Heh. (For my first goal, see here.) I've been composing this post in my head for a while now, but I've been putting it off because it seemed like a complicated post with multiple issues to address, and I never quite had the head space to write it. With only one day left in the month, however, it's kind of become a now or never post. So here goes.

Before getting to my goal, I need to give a bit of background. Like many women in our weight-obsessed society, I've spent a good portion of my life dieting. I can remember dieting as early as grade five, when I filled a school notebook with an elaborate scheme in which I could eat certain foods in exchange for doing certain exercises. It was an utterly ridiculous diet (I seem to recall having to do 50 situps to get a banana), and it didn't last long at all, but it did mark the beginning of almost two decades of battling with my body. Ironically, I dieted for about ten years before I was ever actually "overweight" by any medical definition.

The most "successful" diet I ever went on was about seven or eight years ago, when I went on Weight Watchers. Thanks to the "points" system and the constant reinforcement I received from people who told me how good I looked, I was able to deprive myself of food long enough to drop below my high school weight. I felt fabulous about how I looked, but I was otherwise miserable. I was hungry to varying degrees for literally every minute of every day. I was obsessed with food, fantasizing about the next meal I would eat or about the next time I would have enough "points" saved to eat half a chocolate bar. And most importantly of all, I discovered that being thin didn't miraculously make everything else in my life better. I was still dating a jerk, I still hated my job, and I still lived in a city where I had few friends and absolutely no family. The wonderful life that all of the diet ads had promised me never materialized.

So I stopped dieting and vowed to never diet again. As a result, I've regained all of the weight that I lost, but I've settled into a fairly constant and comfortable weight for myself, and I've stopped living a life of deprivation and self-loathing. The improvement in my mental health has been more than worth the increase in my pant size.

Unfortunately, "not dieting" for me has often translated into "eating garbage". And while I'm comfortable with where my weight is from an emotional and psychological perspective, I recognize that the foods that I eat don't always promote good physical health. So in the interest of not succumbing to one of the many lifestyle-related chronic illnesses, I've been trying to shift my eating away from the garbage and towards healthier choices. My November goal of meal planning was made in part to help me eat better, and it's definitely reduced the amount of unhealthy fast food and cafeteria meals that I've been eating.

Enter my second January goal. I quite innocently decided that I would further improve my eating habits by cutting out a lot of the "extra" things that I eat. The can of regular Coke I drink at Friday noon rounds, the cookie I buy before academic half day, the chai latte that I get at my favourite coffee shop two or three mornings per week - all of those things that aren't essential components of my diet, or even all that satisfying. The idea wasn't to cut out things that I really enjoyed (I will always overindulge at Sunday morning dim sum), but rather to cut out things that I wouldn't really miss. It seemed like an excellent way to improve my eating habits.

And it started out well. At the beginning of the month, I was cutting out one or two things that I didn't really need every day, and it was relatively easy. So easy that I started to get cocky and to think "I could cut out more". And that was the point at which a little switch flipped in my brain, and I went from "cutting back on a few unnecessary things" to "depriving myself of things that bring me joy". To the point where I would stare at a cookie (or bowl of ice cream or chocolate bar) for five minutes, debating whether I really wanted it, or whether I was going to be "good" and not have it. It was like I was right back in the middle of my dieting days, and it wasn't a good feeling at all.

So, in the interest of preserving my mental health, I stopped. I decided that eating a few "extra" treats every week was much better than feeling deprived or judging myself for my lack of willpower and self control. Clearly, my second January goal was an epic fail from a healthy eating perspective. But from the perspective of reminding myself of why I should never diet, it was a definite success.

Why I Was Freaked Out

2012-01-29T09:55:00.001-06:00

Those of you who were reading my blog last fall may remember how I nearly soiled myself when the Parkbeg, Saskatchewan grain elevator unexpectedly collapsed behind me. For anyone who wishes they could've experienced my fear personally, I recently discovered a video of the grain elevator being demolished on YouTube.

It doesn't quite capture my complete and utter terror, as the people making the video knew that it was a controlled demolition, unlike me who thought that the giant structure was being brought down by the wind a few short feet behind me.

I still get palpitations watching the video. I wonder if there are psychiatrists who treat grain elevator collapse-induced PTSD. I see a whole new niche of psychiatry just waiting to be developed.

Unrealistic Expectations

2012-01-27T23:32:00.004-06:00

This weekend is the second weekend in a row that I'm not working - joy! It's exceedingly rare for me to have two back-to-back weekends off (the last time this happened was in July), so I want to make the most of it.

When I have an isolated weekend off, it's hard to be really productive because I'm so tired from the 12- or 19- or (all that is good in the world-forbid) 26-day stretch that I've just worked. Saturday is usually spent alternating between sleeping and wandering around my apartment in a stuporous quest for food, while Sunday is spent in a frantic effort to socialize and fit in all the tasks that I don't have time for during the week. But when I have two weekends off in a row, the second weekend is pure bliss. I feel like my work week is just barely getting started and - tah dah - suddenly it's the weekend again. I'm well-rested, in a good mood, and ready to take on the world.

Which is why I'm cheerfully dreaming about all of the things that I can do this weekend:

haircut (done!)
meal plan (done!)
groceries (done!)
go to yoga class (scheduled for 10:45 tomorrow)
get together with friends (scheduled for post-yoga)
cook (pancetta-wrapped pork tenderloin tomorrow and polpette Napoletane on Sunday)
study
send out emails re: electives, research, career planning meetings
write 1-2 additional blog posts

Sounds like a perfectly reasonable set of goals for the 48 hours between now and the time when I need to go to sleep on Sunday night. Unfortunately, my brain refuses to stop there. Once I get started on my to do list, it just keeps throwing ideas at me until all of the following (and many more) are added to my list:

organize bedroom closet
organize kitchen cabinets
organize storage space
shop for clothes
back up photos
send photo CDs to friends/family
make potato pizza
read photography book/go on photo-taking expedition
watch movie
finish transferring all music CDs to laptop
visit nieces
visit Grandma in hospital (she had a FOOSH earlier this week but is recovering well)
visit Mom

And on and on and on. An absolutely impossible list for the time I have available, unless I discover an as-yet-unrealized superpower for multitasking. I suppose I could get my nieces to search online for clothing for me while my Mom helps me organize my closet and my Grandma makes meatballs in the kitchen. Hmmm....

Oh yeah...and I also want to just chill and enjoy my weekend. /facepalm

How Do I Put the Brakes on Life?

2012-01-25T22:20:00.000-06:00

Today marks the halfway point in my four-week palliative care rotation, and I wish I could make it go by more slowly. Despite the discomfort that I spoke about yesterday, I'm thoroughly enjoying my time on the rotation. A very small part of that is the schedule (9 am to 4:30 PM), but mostly it's the work itself. I feel like what I'm doing has meaning and importance, something that can be lacking for me in other areas of medicine. I derive a huge amount of satisfaction from taking someone who is in pain, or nauseated, or confused and making them feel better, particularly when they're nearing the end of life. And I'm excited by the possibilities for expanding the reach of palliative care and integrating it into oncology at earlier stages. There's huge potential for good within this field.

I spoke with one of the fellows today about how much I'm enjoying the rotation, and she looked me in the eye and said frankly "Then come back and do a fellowship." She then paused, staring at me thoughtfully, before saying "Some people don't fit with palliative care. But others do. And you just fit."

Huh. So much for my fears that I'm not any good at this.

So my brain is now buzzing with dreams of the future and career planning and thoughts about what I want my life to look like in the coming decades. And for the first time in a while, I'm feeling excitement about the future instead of a sense of impending doom as the deadlines for fellowship applications rapidly approach. My plan right now is to go forward with a focus on both oncology and palliative care (sorry hepatology and hematology), anticipating that my career will involve one or both of these fields. Looking ahead to the next few years, I can see a number of ways that this could play out:

1) Do an oncology fellowship (2 years) and then practice full-time as an oncologist. Any time (electives, research, etc.) spent in palliative care during my training would help me to better treat patients' symptoms and support them as they approach end of life, but I wouldn't make palliative care a major part of my work.

2) Do an oncology fellowship (2 years) followed by a palliative care fellowship (1 year) and then have a joint oncology-palliative care practice. There are a number of attendings at my institution who have done this, and they're some of my favourite attendings to work with. I could see myself becoming one of them.

3) Finish a general internal medicine residency (1 additional year) followed by a palliative care fellowship (1 year) and then work exclusively in palliative care. Any time spent in oncology would be useful from the perspective of understanding disease processes and treatments, but I wouldn't practice in oncology.

One of the nice things about these scenarios is that scenarios one and two have the same starting point, so I could begin an oncology fellowship without having made a firm decision about a palliative care fellowship. If I love oncology and want to do it full-time - great, I can start working a year earlier. If I still feel drawn to palliative care and want it to be a major part of my practice - great, I can still enroll in a fellowship and make that happen. I think this is what is called a "win-win" situation.

Over the past weekend, I started doing some of the things that are needed to make this happen. I arranged a meeting with an oncologist to talk about career paths, I emailed schools about visiting electives and now have an elective tentatively booked for May, and I emailed another oncologist about setting up a research project. There's still a ton more to do, but at least now I have a plan that I'm excited about.

If only I could skip right through the next year and a half of things that aren't nearly as exciting...

Things that Internists are Bad At

2012-01-24T22:31:00.000-06:00

Mornings on the Internal Medicine ward are always chaotic. With 8 to 10 patients to care for (or more on a busy service), there is never quite enough time before rounds start at 8:30 to follow up on new test results, review any new notes in the charts, check vital signs, and examine all the patients. As a result, rotating through Internal Medicine teaches residents to be efficient and to minimize all aspects of patient care that don't contribute directly to the primary outcome of making patients better. Unfortunately, this can mean minimizing the amount of time spent talking with patients and getting to know and understand them on a personal level. As much as we want to connect with our patients, we often sacrifice connection in the hope of providing better care to the physical body.

Which is why Palliative Care can be such a foreign concept to an Internal Medicine resident such as myself. Not the pain and symptom control aspects of it - I'm very comfortable assessing physical symptoms and pulling drugs from my arsenal to treat them - but the psychological, social, and spiritual aspects of it. I've spent my evening reading various articles on Palliative Care (see here and here), and a recurrent theme throughout is that one must address the non-physical aspects of suffering in order to provide good end-of-life care. Simple enough in theory, but how on earth do I do this? How do I, who am constantly being taught to be objective and evidence-based in my approach to medicine, suddenly start grappling with intangibles like spiritual and existential crises? And in my inexperience in this area, how do I keep from doing or saying something that will just make the situation worse?

I keep running up against this discomfort and lack of familiarity in my encounters with patients. I feel comfortable, competent, at the beginning of the interview when I'm discussing physical symptoms, but as soon as a patient starts talking about his or her grief or hopelessness or spiritual pain, my brain fills with flashing red lights and a panic alarm screaming "Abort! Abort!" It takes all of my emotional reserves to stay rooted to the spot and be present with the patient rather than fleeing with a promise to consult Spiritual Care or someone else who is "good at this kind of thing". It's foreign to me to feel so out of my element in what I'm doing.

Perhaps some of this stems from my own unresolved grief. When I'm still lacking closure and comfort about my Dad's death, it seems empty and hollow to offer comfort to others. The suffering of others is a reminder of my own suffering, my whole family's suffering, and of the magnitude of loss that one can't appreciate until they experience it for themself. I want to offer promises that everything will be okay, but I know from experience how much time and grieving must pass before it is. And I know too that things are never quite fully okay, that a person's absence will be forever present. Knowing this, what on earth do I say to someone who is just beginning to grieve?

Oh The Places You'll Go!

2012-01-22T21:09:00.001-06:00

For the past week and a half, I've been immersed in end of life care. My days have consisted of talking with people about death, adjusting medications to improve symptom control, and one by one removing patients from my list as they pass on to whatever may come next. It's important work and very much in line with my philosophies about end of life, but it can be difficult on the soul at times.

Spending too much time around death can make one forget that there is still a tremendous amount of living that happens first. Fortunately, I was reminded of the living part of it yesterday, when I got a phone call from one of my friends who was 35 weeks pregnant. When I greeted her as "Mom-to-be" she said "Well....not a Mom-to-be anymore."

Five weeks early because he just couldn't wait to get out into the world. Welcome to life baby boy. You have no idea how much wonder is in store for you.

Baby It's Cold Outside

2012-01-19T22:28:00.002-06:00

Thanks to everyone who commented on my last post about the anonymity (or lack thereof) of my blog. The response I got was the perfect illustration of why I want to keep my blog public - I love getting feedback and different perspectives from everyone who reads my blog. (It was also really nice to hear that people would miss my blog if it went away.) While I could certainly invite everyone who is currently reading to a password-protected blog, it would prevent me from attracting any new readers or from participating in things like Grand Rounds, which I really don't want. So, barring major pressure from a regulatory agency or my program, the blog is here to stay.

(Insert loud applause.)

I'm really appreciative too of everyone who said that I haven't posted anything "bad" here. When I first started blogging, I was extremely careful to not post anything that could remotely identify a patient/work situation/friend, but I know I've gotten more lax as my comfort with blogging has increased. It's nice to know that other people think that what I've been posting is appropriate and not likely to get me into trouble. Fingers crossed at least.

With that out of the way, back to the present...which is ridiculously cold here in my corner of Canada. So cold that the two heaters in my apartment are running almost 24-hours a day, the "antifreeze" in my car has frozen, and I have not physically been outside in at least three days. (Thank goodness for underground parking and the tunnels at work that keep me from losing limbs to frostbite.) It's too cold to go to the grocery store, so I'm subsisting on the rapidly diminishing supplies in my fridge and freezer. Thankfully they include some tasty tortilla soup.

I'm off this weekend (woo-hoo!), and I plan to see as few people and spend as little time outside as is humanly possible. My last few weekends off have been very heavy on the socializing, so I'm looking forward to some quiet time at home to study and start setting up future electives. I've finally come up with a plan for my future (post to come on that soon), so it's time to start moving forward in that area. (I may also spend some time lying on my couch in pjs eating baked eggs. Mmmmm.)

Anyone have any suggestions of warm things to cook this weekend?

Anonymous Blogging

2012-01-17T20:19:00.000-06:00

One of my friends is an avid reader of medical blogs and periodically links to blog posts on her Facebook account. Today she posted a link to a blog post that I had commented on - as Solitary Diner, of course - meaning that if someone follows her link and then happens to read the comments, they could easily link through to my blog. My blog that is filled with identifying information (age, gender, residency program) and photos (like my easily recognizable cats).

Even though I've always blogged with the understanding that I might be "found out" someday, I've managed to delude myself into believing that no one I know will ever find my blog. I like the thought of being anonymous and therefore able to share my thoughts freely and without fear of repercussion. Seeing how close the "real world" is to my "blog world" is a reminder that I'm really not anonymous and that I need to be very careful about what I do and do not share here.

I'm not sure what this will mean going forward. I'm really enjoying blogging and getting feedback from everyone, but ultimately I can't put my career or my personal life in jeopardy over blogging. Maybe this will mean I'll need to password-protect some of my posts, or maybe I'll just have to be even more careful about what I choose to share.

If you're an "anonymous" blogger, how do you decide how much information to share on your blog?

Sunday Afternoon Miscellaney

2012-01-15T14:47:00.000-06:00

My head is buzzing with many thoughts, all of which are either not significant enough or developed enough to form a blog post, so I thought I'd do a post of short tidbits to share what's going on in my life at the moment.

Grief:

Thanks to everyone who left a comment on my previous post about still grieving my Dad's death 27 months later. It was both comforting and disconcerting to read all of your stories about how you're still grieving years after a loss - comforting to know that I'm not alone in my prolonged grief, but disconcerting because I would really like to just stop being sad about my Dad's death. He was a wonderful man and a huge part of my life, though, so I suppose I just need to accept that I will always feel some degree of sadness about him no longer being here.

I really hope my Mom lives forever, because I'm not sure I can handle doubling this grief.

Palliative Care:

I'm enjoying my rotation so far, but it's very odd to be an Internal Medicine resident working in Palliative Care. The entire mindset is the opposite of what I'm used to. In Internal Medicine we have to know every detail about our patients, and we thoroughly investigate every little thing that could or does go wrong with them. It's very different to care for a palliative patient who has IV fluids running without daily blood work, or to not know the cause of a patient's heart failure, or to have a patient who's short of breath but doesn't get an x-ray or a blood gas. It's also different to work in a field that is so absolutely and completely patient-centred. Every treatment decision I make is run by the patient or surrogate decision maker to make sure that it's in line with their treatment goals and what they think will make them feel better, rather than what experience or the literature has taught me will make them feel better. It's a strange but welcome approach to treating patients, and I feel like I'm growing as a physician from my exposure to it.

Cats on a Diet:

On a lighter note, my cats are too fat.

"Jabba the Cat wants more treats!"

So now my cats are on a diet, with the approval of my dear friend The Vet, who provides me with veterinary advice in exchange for me listening to her health concerns and then telling her to go see her actual doctor. Putting my cats on a diet is about as much fun as it sounds. For an idea of what my life looks like right now, check out Simon's cat. Clearly Simon's cat was also on a diet.

Home Call:

Apparently my transfer has arrived on the Palliative Care ward, so it's off to the hospital I go. Wishing everyone well on this cold and grey Sunday.

Recurrent Grief

2012-01-12T22:31:00.000-06:00

Before my Dad died, whenever I would read someone's blog post mourning a loss (partner, family member, unborn child) from years earlier, I would wonder why on earth the author didn't just get over it already. It seemed to me that grief ought to be limited, with an expiry date after which the mourner could simply move on with his or her life and never again be burdened by sadness about the loss.

And then I experienced the loss of my Dad. The grief of that experience was so terrible and vast that I couldn't process it all at the time, particularly not when I had my final year of medical school and the residency application process to get through. So I've been processing it bit by bit, mostly at predictable times like anniversaries of his death and special occasions when it's expected and socially acceptable to remember someone you've lost. But every once in a while, I'm forced to process it at a completely unexpected and inopportune time.

Enter my current rotation in Palliative Care. This morning, the first day of the rotation, we had introductory teaching sessions on symptom control, opioid pharmacology, and communication regarding end of life. During the communication session, as we reviewed different scenarios that we may encounter with palliative patients, I felt as if I had been transported back to the months between my Dad's diagnosis and his death.

"Patients may be afraid of the symptoms that they'll experience as they're dying, such as pain and shortness of breath."

"Family members may have difficulty talking with the patient about death and acknowledging what is going to happen."

"Although you are ultimately responsible for the care of the patient, it's the family and other people around the patient who will be left behind after the death to grieve, and therefore it's important to consider their experience of the death as well."

Almost everything the speaker said brought back a memory, with all of its associated emotion and regret. I was a bit shocked by the rawness I felt and by the way my breath caught in my throat as I struggled to mask my distress. I came close to losing it when someone asked a question about the ethics of letting family members believe that brain dead patients could hear them, as I couldn't shake the image of my Mom talking to my Dad long after he'd fallen into a coma. It was only the distraction of my iPhone and a deliberate tuning out of the discussion that enabled me to stay in the room.

Part of me hates that I respond like this. I like to think of myself as rational, well-adjusted, pragmatic. Not as someone who can still break down over her father's death 27 months after the fact. I like to think that I can still go back to a time in my life when I was untouched by death, when I subconsciously believed that everyone I loved was somehow uniquely immortal in a world of otherwise mortal people. But I'm not, and I can't. So anyone reading this will just have to bear with me as I continue to write posts about my Dad's death, even when it's long past the expiry date for my grief.

Revolutionary

2012-01-12T07:54:00.001-06:00

Something amazing has been happening over the past four days - I've been waking up feeling not tired. I mean, I've been tired in the always-wish-I-could-get-more-sleep kind of way, but not in the not-certain-I'll-make-it-through-the-day-without-falling-asleep-in-an-inappropriate-place kind of way. It's been absolutely wonderful. And all I had to do was give up my late night channel-surfing/Epicurious-browsing/blog stat-reviewing ways. It's definitely worth it.

Score one for my first January goal. (A post on my not-as-successful second January goal to come on a night when I get home more than two hours before my bedtime.)

January Goals - Part One

2012-01-09T22:03:00.001-06:00

As may have been evident from my early Saturday morning post, by the end of last week I was pretty spent. I was so exhausted, physically and mentally, that I was having a hard time focusing at work, and I was about as grouchy as I ever get. I went for dinner with some friends on Friday night, and I could barely keep my eyes open through the entire meal, let alone be an active participant in the conversation.

But today...ah, today. After two days of getting a reasonable amount of sleep, I felt like a completely different person. Despite arriving at work to find that my resident who had been on Friday-Sunday call had gone home sick, leaving all of her patients still to be seen and cared for, I managed to hold it together well on rounds. I don't want to think about how I might've responded if the same thing had happened last Friday.

The unfortunate thing is that I'm my own worst enemy when it comes to sleep. Every evening I start out with good intentions, but then bedtime arrives and I want to read one more blog or watch a few more minutes of tv. I'm as bad as my nieces, who always want one more book or another glass of water before going to bed. Inevitably, I find myself pushing my bedtime 15...30...45...60 minutes later, until it's physically impossible to get a good night sleep.

So, my first January goal is going to be to go to bed a full eight hours before I need to get up in the morning. Not heading to bed or quickly checking my blog or packing a lunch - physically in my pjs, teeth brushed, alarm set, and in my bed. It will likely mean a bit less commenting on my blog and on other people's blogs, but it'll be worth it if I can be a better rested and higher functioning human being. We'll see how it goes.

And now, it's one minute past my bedtime, and I still have a lunch to pack, a litter box to clean, teeth to brush, and pjs to change into. Apparently my goal starts tomorrow.

Middle of the Night Chart Review

2012-01-07T07:08:00.000-06:00

Whenever anything on my ward goes wrong, particularly when someone dies unexpectedly, I go through the case over and over again in my mind, searching for the thing that I could've done differently to change the outcome. Clearly there's value in this from a learning perspective, but there's a fine line between self improvement and torturing oneself with unnecessary guilt. Look hard enough at any chart, and you'll always find something that could've been done better.

Which is why I'm awake in the wee hours of the morning, despite being exhausted to almost my breaking point, reflecting and self berating and wondering whether I'm competent to do the work that I set out to do. I try not to do this to myself, try to be forgiving of my own imperfections, but my brain is filled with well-established neural pathways of self doubt and blame that will fire in response to the slightest of stimuli. So instead of sleep, I come here and try to purge myself of the false belief that if I were only better, smarter, more capable that I could somehow prevent anything bad from happening to one of my patients. That somehow it's only my weaknesses that prevent me from reassembling the broken people who are entrusted to my care.

Anonymous Doc is Reading My Mind

2012-01-05T22:03:00.001-06:00

I have a brand new crop of medical students on my service, which means a lot of hand holding and double checking and explaining seemingly basic things. My memory tells me that I was far more competent when I first started on the wards, but I'm sure that any number of my senior residents would be happy to correct my memory.

As a result of the last few days with the newbies, I couldn't help but laugh hysterically when I read this post by Anonymous Doc. It captures the feeling of my day so beautifully.

I'm now off to sleep so that I can deal with tomorrow, which is the last day before the weekend. Woo-hoo!

The Resolution Post

2012-01-04T20:42:00.002-06:00

I can't honestly remember the last time I made a New Year's Resolution. I used to make them every year, usually of the exercise more/eat less/lose weight variety, but I gave them up years ago after never managing to keep them. I figured that the world did a good enough job of making me feel like a failure without me helping it by providing an annual itemized list of things at which I would inevitably fail.

Which is why I'm not going to make any New Year's Resolutions this year either. I've been thinking about it for weeks, planning out the resolutions I could make, and composing blog posts in my head, but it's just not my nature to make New Year's Resolutions any more. I don't want the beginning of my year to be marked by a frantic and ultimately unsuccessful attempt to suddenly change into a better, thinner, more accomplished version of myself. I want the beginning of my year to be filled with joy and hope and the possibility of wonderful things happening. And I don't need resolutions for that.

However....there are some changes that I want to make and some things that I want to accomplish in the upcoming year. And I think my likelihood of being successful is greatly increased if I at least outline some of the things that I want to do. So here, instead of a list of resolutions, is a description of the things to which I want to devote my energy in 2012.

Becoming a better doctor: I've committed myself to medicine because I believe that it's a way of contributing something positive to the world while enjoying myself in the process. I'm passionate about my career, and I'm not content to just be a mediocre doctor who doesn't get sued. I want to be great at what I do. That means hitting the books, consistently and with a plan. I've done a decent job of this in the past year, but I want to study more and focus on the things that I need to study, rather than just the things I'm interested in. It also means setting up the study group that I've been thinking about for the past year and a half, but still haven't gotten around to organizing.

Preparing for my future career: 2012 is going to be one of the more important years in my training, as this is the year that I'll pick a field and apply for fellowships. I need to devote a significant amount of time and mental energy in the very near future to finding a research project, applying to out of province electives, and speaking with people in the field(s) to which I want to apply. It's a terrifying process for me, as it means that I have to decide between oncology, hepatology, and hematology, and it also means that I have to come to terms with moving to a different province in just 18 months. But the deadlines are going to come whether I'm ready for them or not, so I want to get ready.

Connecting with friends and family: These are the people who keep me sane and make life worthwhile, so they're the people with whom I want to spend any extra time I may have.

Taking care of my health: My health was probably the thing that suffered the most when my Dad was diagnosed with melanoma, as it was easy (and fun!) to eat poorly and stop exercising. Unfortunately, I'm reminded by the patients I see every day that there are consequences to neglecting one's health, and not taking care of myself makes me feel like crap. I've made steps towards better health in the past year by doing more cooking, but I still have a long way to go. In 2012, I want to keep eating better, get back to exercising, and get more sleep. Much, much more sleep.

Experiencing life deeply: Looking at what I've written up to here, I already have a lot laid out for 2012, but I don't want the year to be all about work and self-sacrifice and preparing for the future. I know that I'm not guaranteed anything more than the current moment, and that it's entirely possible (although unlikely) that I won't live to see the end of 2012, so I want to keep living through the process. I want to travel to new places and experience new things and really be a participant in life. Even when I'm tired. Especially when I'm tired.

So that's it. My list of things that aren't quite resolutions, but that are priorities to help me better focus my energy in the upcoming year. My thought is that I'll use this list as a source of monthly goals - small challenges to help me move in the right direction - rather than as something against which to measure my failures. Sounds better than resolutions to me.

Where do you want to put your energy in 2012?

Tired Again

2012-01-03T21:46:00.001-06:00

One of the nice things about being a second year internal medicine resident at my university is the call schedule. Because of our night float system, most of the call that we do is home call, and most of this requires little to no going into the hospital overnight. (Except for the nightmare of Neurology, which was thankfully only two weeks long.) We generally only do in-house call once a month, during which we cover the emergency room consults and act as backup to the teams on the wards. It's a relatively cushy schedule, and I've gotten very used to not doing long, soul-destroying overnight call shifts.

Which is why the two back-to-back overnight calls that I did over Christmas completely kicked my ass. I had forgotten how difficult it was to be on call for 24 hours and then to start rounding and writing notes on my patients on the second day. In four days I did almost one and a half weeks of full-time work. And I now feel completely and utterly horrible.

Which is not me asking for pity. (Well, maybe just a wee bit. Especially because I'm so tired that I just typed "pitty". Like "kitty".) It's just me explaining why my posts on New Year's resolutions and my January goal will have to wait a while. Like maybe into February. For now, I'm going to bed, hopefully to emerge feeling somewhat human tomorrow.

Hope 2012 is treating everyone well so far.

2011 - The Year In Review

2012-01-01T20:32:00.003-06:00

New Year's Eve has always been one of my favourite holidays. Being a completely secular holiday, it feels like one of the few holidays that I can fully participate in as an atheist. It also has no defined rituals or mandatory family gatherings, so one can celebrate it in whatever way one chooses (for me, usually something low-key with friends). And I love the idea of reflecting back on the previous year while looking forward to the new one that awaits. For me, it's a moment for slowing down and contemplating where I am in my life, as well as where I'd like to go.

Unfortunately, medicine is rarely compatible with slowing down and self-reflection, so I've spent the past four days either on-call or recovering post-call instead of enjoying the holiday. My great New Year's Eve celebration last night did not involve gathering at my friends' house for appetizers and drinks as I would've liked, but rather involved sitting alone in the residents' lounge watching a time-delayed celebration from my nation's capital on tv. On the upside, the hospital cafeteria put out free food for all of the staff at 1 am, so I got to enjoy a turkey sandwich and oatmeal raisin cookie with another on-call resident in the middle of the night.

Now that my call shifts are behind me (no more in-house call for the next five weeks!), I finally have the chance to put down some of my thoughts on the year that just came to an end. Looking back at 2011, it's been a relatively low-key year. There haven't been any major crises (thank all that is good in the world), nor major changes in my training, nor big exciting personal developments. It's just been a fairly nondescript year in which I've slowly plodded forward on my way to completing my medical training and becoming a fully licensed physician. Here's the breakdown of the year, as I see it:

Medicine: Work has, without question, been at the forefront of my life over the past year. It's been the main focus of my time and energy, often at the expense of the people and the pastimes that I love. But not without good reason. I chose this career path deliberately and after a great deal of reflection, so I'm usually happy to make sacrifices and work hard in order to develop as a physician.

Looking back, this has probably been one of my bigger years in terms of my professional development. At the beginning of 2011, I was still an insecure first-year resident who would be filled with dread as I watched the other house staff head home at the end of the day, leaving me alone and in charge of a ward full of sick patients for my nights on call. Over the course of the year, I've gotten comfortable not only with managing a ward on my own, but also with managing a team of trainees who count on me for guidance and knowledge. My stress level, which once was enough to keep me from sleeping or eating with any sort of regularity, is now at a fairly low and manageable baseline level. (Except during codes, when the tiny voice inside my head still screams "Panic! PANIC!" while I try my best to appear calm on the outside.) I actually have moments of confidence in myself, and on the whole feel like I'm capable of developing into a good doctor. Most of the time.

Friends: My friendship circle has shrunken a bit since finishing medical school, as old friends have moved away to residency positions in other cities, and local friends have gotten busy in residency programs that are vastly different from my own. There's been further change amongst my friends in the past year, as one of them has had her first child (a lovely baby boy born back in July) and another has gotten pregnant with her second child (due in February). The dynamics are completely different with two babies in the mix, and so long leisurely dinners in restaurants have given way to smaller gatherings in people's homes and cooing over the newest addition to the world. It's been a bit of a challenge to adjust to the new division between "those who have kids" and "those who do not", but we're a close group of friends, so we're finding ways to make it work. Even if that sometimes means that "those who do not" meet up at the local tapas bar, while "those who have kids" pass out on the couch in their toy-filled homes.

Welcoming my friend's new addition at her baby shower.

Family: My nieces continue to grow bigger and more mature, yet somehow they still love their Auntie Solitary. I am never able to spend as much time with them as I want, but thanks to co-workers who are willing to switch calls and caffeine to keep me awake, I've been able to make it to most of the important events in their lives. It's wonderful to be in the same city as them, and I try to take advantage of their close proximity as much as I can.

Playing Monopoly Junior with the nieces.

My Mom continues to both amuse and annoy me, in equal measure. This year has been a very difficult one for her, as she's found herself struggling with my Dad's death even more than she did in the first year after he died, but she's plugging along. She's starting to make plans to move into the city to be closer to family, which I think will be a positive for all concerned. As long as she doesn't start dropping by at my apartment unannounced.

Personal: This has been a year of "never enough time" for me. There is always more that I want to do - reading, taking photography lessons, exercising, eating better - but never enough time to fit it all in. I suppose it's a good thing to be busy doing things I enjoy, but sometimes I just want a long stretch of uninterrupted and unscheduled time.

Over the past year, I have managed to find the time for two trips, one to Hawaii and the other to Alberta. The first trip was to a truly incredible place, although I didn't always have the most incredible time, as I didn't travel particularly well with the friend who went with me. Far too much of the trip was spent in strained silence or (worse) yelling at each other over what to do and when to do it. Fortunately the friendship survived the trip, and I at least have some great photos as mementos.

Beautiful waves on Oahu.

The second trip was also to an incredible place, and was one of the most pleasant and needed vacations of my life. It was a completely unstructured trip, and I enjoyed being able to do whatever I damn well pleased with my days. I slept a lot, drank a lot of coffee (slowly for once), and took thousands of near-identical mountain pictures. It was absolutely divine.

Athabasca Falls, just outside of Jasper Townsite. (Umm...no falls are visible in this picture.)

The other big thing that I managed to do this past year is start cooking again. Back in November I set a goal for myself to plan my meals every week, and it's led to me doing a lot more cooking and a lot less eating out. Although sometimes takeout sushi still wins.

And of course, I started blogging! While my "official launch" was in 2010, this is the first year that I've blogged regularly and actually established a group of loyal readers. I've really enjoyed getting some of my thoughts and frustrations out into the world, and I've especially enjoyed the great comments that I've received. Please keep reading and commenting, as I read every comment that I receive, and they definitely influence my thoughts on the world and my interpretation of life.

In Summary: All in all, I can't complain about 2011. It's been busy and tiring and rough at times, but it's also been a year of experience and growth. I'm thankful to have enough good memories of the year to overshadow any bad.

Wishing you all a very Happy New Year! Stay tuned for my thoughts on the upcoming year....

Looking Ahead to 2012

2011-12-31T12:00:00.001-06:00

I have posts brewing about the year in review and about my resolutions for the new year, but they'll have to wait until I emerge from the fog of holiday ward coverage. In the meantime, I was inspired by a post by Larissa at Thoughts Simply Arise about the things that she isn't giving up in 2012. Too often resolutions focus on sacrifice and self deprivation, so it's nice to remember that there are many things that we should continue to enjoy.

So here, in the spirit of enjoying the new year, are the things that I won't be giving up in 2012:

Lazy post-call days spent cuddling with my cats and watching trashy tv.
Solitary breakfasts at my favourite diner.
Chocolate.
Time with my two adorable nieces.
Cozy pjs.
Long visits with friends over food and coffee. (I already have dim sum booked for my next weekend off.)
Excessive amounts of Coke Zero while on call.
My housekeeper, who keeps me from living in squalor.
Travel funded by my line of credit. (Looking ahead to Mexico and maybe Newfoundland in the upcoming year.)
Grilled cheese made with sourdough rye bread from my favourite local bakery. (Also known as crack bread because it's so addictive.)

Sleeping in whenever humanly possible.
Blogging.

Wishing you all a Happy New Year. Wish I could be there at midnight, clinking champagne glasses and kissing people I love, but I'll hopefully be dozing in my call room.

Breaking Bad News Revisited

2011-12-30T19:45:00.002-06:00

Thanks to everyone who commented on my previous post about the worst possible way in which to tell a patient that he has cancer. Although I obviously can't go into much detail because of patient confidentiality, I wanted to clarify the situation a bit so that the person I took over from doesn't come across as being a terrible doctor who withholds information from her patients.

As is often the case with cancer, the patient's diagnosis wasn't made instantaneously, but rather became increasingly clear over a series of days as more and more test results came in. Even at the time that I spoke with the patient, the final diagnosis wasn't entirely certain, although we had a pretty strong case for the most likely diagnosis. For right or wrong, every doctor has his or her own way of dealing with this diagnostic uncertainty. As I've progressed in my training and grown more comfortable with my knowledge and understanding, I've made a conscious decision to try to involve patients in the diagnostic process as much as possible. I try to communicate results and my thoughts about the diagnosis on an ongoing basis, even when the diagnosis isn't yet 100% certain. But this is a very difficult thing to do, and it can lead to situations in which patients are told about a possible diagnosis that ultimately proves to be wrong. And so some doctors will choose to defer telling a patient about the most likely diagnosis until they've reached the point of certainty, as was the case with the patient whom I inadvertently told about his cancer diagnosis. In fairness to his previous doctor, she had already told him that there was a chance he had cancer, she just hadn't delivered the news with quite as much certainty as I did.

Cartoon Character made a very good point in her comment, in which she stated that she typically asks patients "what have you been told about your diagnoses/treatment?" before talking to them about what's going on. Although this can be tiring and frustrating for patients, as Anonymous pointed out in his/her comment, I think it can be an important tool for avoiding situations like the one that I got myself into. I do typically try to ask that question, particularly when I'm taking over a new patient, but with this patient I was rushing and didn't take the time to ask. In retrospect, big mistake. If I'd just taken a few minutes to clarify the patient's understanding, I could've delivered the news of his diagnosis in a much more compassionate and sensitive way.

I have many more thoughts that have come out from the great comments on my post, but at the moment I'm post-call from covering both a medical ward and the emergency room, so I'm not certain that I even have the mental energy to finish watching TLC's "Say Yes To The Dress" marathon. Hopefully more to come once I get some much-needed rest.

Breaking Bad News - A Cautionary Tale

2011-12-28T21:10:00.001-06:00

Today was my first day back at work post-holidays. My ward has about 20 new patients with whom I needed to familiarize myself, so I spent my day diligently reviewing charts, checking blood work, and introducing myself to all of the new patients. At the end of each meeting, I gave each patient a summary of his or her treatment plan, both to bring the patients up to date with what's going on and to reinforce the plans in my own mind.

So it was that I found myself discussing the plan with a patient who was diagnosed with cancer just a few days earlier. As I talked to him about the new medication we had started, I noticed that he was looking at me quite strangely. His expression grew even odder when I mentioned the further testing that we had planned. When I told him that the oncologist would be coming by to see him later in the day, his expression turned to one of complete and utter shock, and I finally clued in to what was going on.

No one had told this man he had cancer.

And I, someone he'd never met before, had nonchalantly walked into his room and started talking about his cancer as if it was no big deal. From now on, whenever this man thinks back to how he found out he had cancer, his memory will be of some random stranger delivering the news unceremoniously and without the slightest bit of compassion.

/facepalm

Welcome back from holidays, Solitary Diner. I feel like just about the biggest jerk to ever exist. Excuse me while I go and extricate my foot from my mouth.

Christmas Recap, In Pictures

2011-12-27T21:21:00.000-06:00

Wrapping presents, with my favourite Christmas special in the background.

Christmas Eve dinner at my brother's house. Very tasty pork-stuffed pork. Mmmm.

Homemade (by me) creme brulee for dessert.

A surprisingly well-behaved canine visitor.

A kitty cat, curled up to spend Christmas Eve with the nieces.

Christmas morning "proof" that Santa had paid a visit.

The most essential component of Christmas morning for the adults.

Presents!

A Christmas scavenger hunt, by my five-year-old niece. (Love the spelling!)

Christmas morning breakfast.

More pork. Mmmmm.

Boxing Day morning at my Mom's house. As pretty as the sunrise was, I didn't need my Mom to wake me up for it.

Boxing Day dessert (homemade pavlova).

So good.

Homemade dainties (to make sure we maximized our caloric intake).

As you can see, there was a lot of very tasty food and multiple celebrations over the past five days. It's been wonderful to have time off and to get caught up with people, many of whom I haven't seen in months. My only regret is how quickly the time went by. It seemed like I was constantly rushing to get presents wrapped and creme brulee made and dishes washed. Tonight is the first time in this vacation that I've had nothing to do*, and I'm enjoying relaxing on the couch with a kitty cat and my laptop. I would happily take another week of this, but unfortunately there are 30 or so patients in need of care, so it's back to work tomorrow. After five such wonderful days, I really shouldn't complain.

* By "nothing", I mean finish my laundry, cut up the peanut butter marshmallow squares that I made to take to work tomorrow, put dinner away, do dishes, and pack a bag for tomorrow. But I'm ignoring all of these things in the interest of some down time.

Christmas With The Nieces

2011-12-25T13:14:00.001-06:00

Seven-year-old niece: "Auntie Solitary?"
Very tired Auntie Solitary: "What time is it, J?"
Niece: "7:13."
Auntie: "Seventeen more minutes, J."
Niece. "I know! That's what Daddy said! But, but, but....Santa was here! Aaaaaand....the stockings are full! Of presents! And there's more presents under the tree, but I didn't go down there, because Daddy said I wouldn't get the presents from Santa if I peaked at them. But I think they're there, because the stockings are full, and Santa leaves the presents when he fills the stockings.....aaaaaand....is it 7:30 yet? Cause Daddy said we could open the presents at 7:30."
Auntie: "It's 7:15. Almost there."
Niece: "Ohhhh.....I think I'm going to EXPLODE! I'm SO EXCITED! It's CHRISTMAS!"

It's Christmas indeed. Hope Christmas has been as exciting and joy-filled for everyone reading this as it was for my seven-year-old niece. And now I'm off to have a nap with the kitties before rounds two and three of the celebrations begin.

Holidays

2011-12-23T09:41:00.002-06:00

Sorry for the whining in my last post. Unfortunately, it was reflective of what I was feeling at the time - overworked, harried, tired, frustrated. And yesterday, if anything, was worse. As wonderful a time as Christmas is in the outside world, it's a miserable time inside the hospital. There is too much work for too few people, staff are putting in their maximum effort just to meet the minimum standards of patient care, and there's an air of resentment that comes from being in a hospital when the rest of the world is eating Christmas baking and drinking eggnog in front of a fire.

The worst part of this season, for me, is feeling like there is no possible way for me to be the doctor I want to be. I pride myself on taking time with patients, being on top of their issues, and being a calm and pleasant person to work with. Neither "calm" nor "pleasant" described me yesterday, as I muttered swear words under my breath or banged my head against the desk (literally, more than once) in frustration. Everyone has their breaking point, and while mine is high, it is reachable. Trying to lead a team of two to excellence is beyond my breaking point.

But, the ward is now out of my hands (despite still pervading my dreams), and I have five glorious days of vacation. My two paragraphs of ranting behind me, I'm now going to try to forget about work and just enjoy all of the magic of the season. I have today and the first part of tomorrow all to myself, and as usual I'm debating between giving in fully to relaxation and trying to accomplish the hundreds of items on my to-do list. Hopefully I'll achieve something in the middle.

Fortunately, my to-do list does not include "go to the mall". Thanks to everyone's suggestions to do my shopping on-line, I managed to get all of my Christmas gifts with minimal stress and without setting foot in a single mall. And I think I even achieved my goal of getting somewhat meaningful gifts for everyone. See what you think:

Mom: A crock pot to replace the one that she broke earlier this year. Not all that exciting, but it should help her with the daunting task of cooking for one. And it will hopefully translate into some tasty meals for me when I find the time to visit.

Brother: A bottle of port. Every year on Christmas Day, the male relatives in my sister-in-law's family sit around smoking cigars and drinking port, so I figured this was as good a gift as any for the brother who has everything.

Sister-in-law and nieces: Tickets to the Nutcracker ballet.

Growing up, one of my friends would go to the Nutcracker with her single and childless aunt every Christmas, and I was always jealous. All of my aunts had their own brood of children to care for, and my mother was far too frugal to ever spend money on ballet tickets, so I had to content myself with watching the ballet on tv. When I found out that my sister-in-law was pregnant with a girl, one of my first thoughts was that I would take her to the ballet as soon as she was old enough. I took my nieces for the first time last year, and it was a bit of a disappointment as the younger of the two (four at the time) was terrified of the mouse army and wanted to leave at intermission. But when I asked the nieces what they wanted for Christmas this year, they both said "Nutcracker!" and proceeded to dance around their living room in a joyful and silly interpretation of ballerinas. So Nutcracker it is.

Older niece: One of the hazards of online shopping is how easy it is to buy more than one needs. So despite having just bought ballet tickets, I decided that my nieces needed a physical gift to sit under the tree and open on Christmas day. So I bought the older niece Ramona Quimby age 8, which was one of my favourite books when I was her age.

I also bought her Pictureka because *ahem* I still owed her a birthday gift from July. I had initially decided to take her out for a "Day with Auntie Solitary" in lieu of a gift, but apparently Auntie Solitary hasn't had a day to spare since July, so a gift it is. My niece loves the Where's Waldo books, so hopefully she'll enjoy a similarly themed game.

Younger Niece: The Nutcracker by Susan Jeffers. I adore Susan Jeffers's illustrations, and I've bought my youngest niece one of her books for Christmas every year for the past two years. This seemed like a good choice to accompany the Nutcracker tickets.

Miscellaneous people I will see at Christmas: Normally I try to buy something small (chocolate, a cute mug, bath products) for the distant relatives and neighbours who join us for Christmas celebrations, but it always feels like such a waste of money. So this year, I decided instead to make a donation to a local food bank and just give cards to people. (I even have multiple boxes of cards that have never been sent sitting in my Christmas box, so I'm all set in that department.) Hopefully no one will be offended that they didn't receive a $5 trinket from me.

Looking at this list, I'm reminded of how fortunate I am to have these people I love in my life and to be able to afford to buy them things they will enjoy. I get a bit cynical at times about the materialism of Christmas, but it is nice to watch a five-year-old's eyes go wide with delight as she rips the wrapping paper off something she loves.

And now, off to the UPS store to pick up the Amazon package containing that something for the five-year old. I hope that all of you reading this have a wonderful holiday with those you love.

And lots of chocolate.

Christmas Math

2011-12-21T20:38:00.002-06:00

The internal medicine wards at the hospitals where I work usually have 30 to 35 patients divided amongst a team of four to six residents and medical students. Medical students are responsible for half as many patients as residents, leaving medical students with three to five patients and residents with six to ten patients, on average. It makes for a busy rotation, but the patient to trainee ratios are still low enough for trainees to get to know their patients well and to stay on top of their medical issues.

Enter Christmas.

Subtract from the team two or three medical students, who disappear from the ward for two blissful weeks of holidays, and one or two residents, who get five short days of holidays to spend dreading their return to work. Then toss in one or two off-service residents, who can barely hide their bitterness about being pulled from the cushy world of oncology clinics to cover 30-hour-long call shifts on a busy and understaffed medicine ward.

(I know this from experience. I was the bitter resident who was pulled from oncology last Christmas.)

The end result is those same 30 to 35 patients, now being managed by a grand total of three residents. And one of those residents is post-call every day, meaning that there are two residents on the ward at any given time. Two.

Although this delightful system doesn't officially begin until Friday, I got a preview of it this morning, when my team of three residents was reduced to one thanks to a resident leaving post-call and another resident being on half day. Between myself, the poor family medicine resident who is five days into his internal medicine rotation, and the ever cheerful pharmacist, it took us five hours to round on the ward (normal time is two-and-a-half hours). By the time we saw the last patient and promptly sent him back to the ICU from whence he came, my heart was filled with despair and I was contemplating alternative career paths. Unfortunately I've yet to identify another career path that would allow me to pay off my six-figure debt.

(And I love my career. Honestly. Or at least I will after five days of holiday drinking.)

I'm trying to think of something wise and insightful to add as I lounge half asleep on my couch, but all I can really think about is how happy I am that tomorrow is my last day of work before Christmas. I am so very ready for it. I reviewed all the patient charts and checked all the blood work before leaving tonight, so the ward is in the best shape that it possibly can be. My Christmas gifts are all bought, my apartment is decorated, and there's enough chocolate in the cupboard to put me into a hyperglycemic coma.

I'm ready Christmas. Bring it on.

Advice to People Attending Holiday Parties

2011-12-17T23:28:00.000-06:00

It is never appropriate to tell your husband's colleague to f@(% off. Even if she did take the last peanut butter marshmallow square.

(Photo from Bake Eat and Grow)

It's 3 am, I Must Be Lonely

2011-12-17T03:43:00.000-06:00

The first week or so as the senior resident on a new ward is always one of the most terrifying and frustrating experiences of residency. With only a two- to three-line blurb on each of the 30-plus patients on the ward, I'm expected to direct a team of five trainees of varying levels of knowledge and experience to provide "optimum healthcare" to our patients. Over the first few days, I can't possibly know more than the bare minimum about each patient, so I'm constantly left fumbling through my own notes and patient charts and computerized lab values to try to figure out what's going on and how best to address the issues that emerge in rapid succession. I write myself long "To Do" lists of charts to review and tests to follow up on, but at the end of the first few days there are always more things left behind than checked off, and I am inevitably left feeling like a failure.

Which is why I'm awake at 3 am, much to the delight of the cat who is curled into my thigh and enjoying the unexpected middle of the night cuddles. My dreams have been invaded by a continuous loop of images from the past two days, and I've been lying half-awake in bed going through a mental checklist of patient issues, searching for things I've missed or could have done better. My middle of the night anxiety isn't helped by the fact that the ward has had bad luck over the past two days and, through no fault of anyone, a number of patients have done very poorly. The continuous loop focuses mostly on the codes and the pre-codes, questioning my decisions, wondering what I could've done better or faster or with more self confidence. Wondering if I could've made a difference for the people who won't make it home for the holidays.

This will get better. I know this from experience. The second day was already better than the first, as my familiarity with patients and my understanding of the strengths and weaknesses of my team members was exponentially higher. But the whole rotation will nonetheless be stressful, four weeks of constantly feeling behind where I should be, not enough for the trainees and nursing staff and attendings and ultimately the patients who are looking to me for guidance and for care.

When I hear or read of people who criticize doctors, who dismiss us as indifferent and money-grubbing and arrogant, I wish they could sit with me now, at 3 am. I wish they could inhabit my dreams, which are filled with columns of lab values and images of CT scans and tables of vital signs, and know how much I think about my patients. I wish they could feel the pain in my stomach, taste the chalky peppermint of the Tums that I chew like candies, and know how seriously I take the work I do. I wish they could see me wiping away tears before I compose myself enough to tell a previously healthy young woman that she's dying and know how invested I am in the outcomes of the people who entrust me with their care. I understand that there are doctors out there who are bad and uncaring, but I'm not one of them.

So now I wait, for my mind to still enough to make another attempt at sleep. Writing this post, exposing my weaknesses and fears for the entire electronic world to view, helps. Because I know that many of the people reading this have been through exactly the same thing, and that there are a few who are also awake at 3 am, thinking, worrying, hoping.

Signs that it's a Terrible, Horrible, No Good, Very Bad First Day on the Ward

2011-12-15T19:49:00.001-06:00

1) You need to comfort a crying team member before rounds have even started.
2) You get your first patient complaint ever. From a patient you haven't even met.
3) In the middle of a code, the ICU attending asks "Is this the patient you wanted us to assess for admission?", and you reply "No, that would be her roommate."
4) Two out of the three remaining team members end up crying before sign out rounds.
5) You start crying the moment Joni Mitchell's River starts playing on the radio while driving home.

Can I go back to Hepatology now?

An Atheist at Christmas

2011-12-13T22:51:00.001-06:00

The timing of this post is perhaps a bit odd, given that I just devoted an entire post to stories of alcohol-infused egg nog and photos of my Christmas tree, but this is a thought that's been weighing on my mind lately, so I thought I'd try to get it down in a post. Before I get into any talk about religion, I want to add the disclaimer that I don't want to offend anyone with what I write here. I recognize that these are my own personal beliefs, not necessarily the "truth", and that everyone is entitled to their own beliefs. I don't mean for this post to be disrespectful in any way towards people who do believe in God.

This year marks the first Christmas that I've considered myself to be an atheist. For decades, probably since I was seven or eight and heard the term for the first time, I've always thought of myself as an agnostic. I never felt that I could know whether there was or wasn't a God with any sort of certainty, so agnosticism to me was a comfortable state of non-belief. As I've gotten older, however, my beliefs about life and the universe have tipped further and further towards the atheist side of the scale. Medicine in particular has done this; through my training, I've been witness to incredible unfairness and suffering that, to me, isn't consistent with the idea of a compassionate supreme being.

The tipping point for me came while reading The God Delusion by Richard Dawkins while on holidays in Hawaii earlier this year. (Because apparently I'm incapable of reading light, mindless books, even when surrounded by some of the most amazing natural beauty in the world.) I won't get into the relative merits or flaws of the book (there are 1751 customer reviews that address them if you're interested), but what struck me about the book was Dawkins's comparison between a belief in God (or belief that there isn't a God) and a belief in a scientific theory. To paraphrase badly, Dawkins says that a person will claim a belief in a scientific theory not because they know with 100% certainty that it's true, but rather because they feel that the balance of evidence is strongly in favour of that theory. Similarly with atheism, a person doesn't have to "know" that there isn't a God to be an atheist, but simply needs to feel that the balance of evidence is strongly in favour of there not being a God. Reading that, and believing that the balance of evidence was towards there not being a God, was enough for me to switch from calling myself an agnostic to calling myself an atheist.

All of which is a long way of getting to my point about being an atheist at Christmas. Being an agnostic at Christmas wasn't all that hard, because even though I wasn't convinced about the religious significance of the holiday, I was still open to the possibility that it was true. I could still go to church and sing Christmas carols and participate in the holiday with some spiritual meaning behind what I was doing. But as an atheist, that's gone. Suddenly a holiday that I've celebrated my entire life feels devoid of any meaning to me. In some ways, I feel like a fraud to be celebrating the holiday at all; it's as if Christmas isn't really mine to celebrate anymore.

Surprisingly, to me at least, this feels like a huge loss. Christmas has always been one of the most magical times of the year for me - a time of sparkling lights and favourite homemade treats and endless visiting with family. And while none of the external aspects of Christmas have changed, the internal purpose and feeling behind it has. I wish in some ways that I could rewind time, unread The God Delusion and unsee the suffering of my patients, so that I could go back to a point in time when I still wasn't convinced that God existed, but I also wasn't convinced that God didn't exist*.

Heck...while we're at it, I'd like to rewind to a point in time when my Dad was still alive. Because to me, nothing epitomized Christmas more than sitting next to my Dad on the couch, egg nog in hand, as he put the scratchy John Lennon album on the record player and played Happy Christmas (War Is Over) for the first time of the holiday season.

Happy Christmas Dad.

*I realize that this is one of the most awkward sentences ever written. It sounded good in my head when I wrote it, and now I can't come up with a better way of phrasing it. Hopefully you'll forgive me and my tired brain for such terrible writing.

It's Beginning to Look a Lot Like Christmas

2011-12-11T22:54:00.001-06:00

My Mom came over for dinner and tree decorating tonight. And maybe a bit of egg nog. I didn't have any rum, so I used Bailey's Irish Cream instead. Very tasty.

I'm starting to feel much more Christmassy after listening to some Christmas music and putting up the tree.

Here's the very tasty dinner of short ribs that I used to bribe my Mom for her services:

Some of the ornaments (old and new) adorning my tree:

A handmade ornament made by my mom decades ago:

And one made by me:

An angel made from sea glass:

It's me!

A reindeer from the Little Travellers Project in South Africa:

Very tired kitty cats after such an eventful day:

I'm now enjoying the last few minutes of my weekend with a cat at my side and a tree shimmering in the corner.

If you celebrate Christmas, how are your preparations coming?

Another Reason to Love Hepatology

2011-12-10T21:11:00.002-06:00

I'm on hepatology home call for the weekend, and I finally understand why it's called "home" call. I haven't been paged once. I can hardly begin to describe how welcome an entire day without work is right now.

When I woke up this morning (at 9:30!), I got inspired by Sarah's post at the SHU box and wrote myself an ambitious "To Do" list. Look at all the productive things that I was planning to do!

In the real world, however, I didn't get much farther than lunch with A, who is out of the hospital on a pass again this weekend. We spent about two hours at a favourite breakfast spot (not this spot, but just as good) and then wandered across the street to a coffee shop where we spent another two hours drinking candy cane hot chocolate. It was divine. I haven't seen A in two weeks, so there was a lot of catching up to do. She's looking better than the last time I saw her, and she's feeling more hopeful, all of which is good to see.

I did get the meal plan written and the groceries purchased. I decided to keep the meal plan pretty simple this week (i.e. mostly leftovers) because I have about a month's worth of frozen dinners in my freezer that I need to start eating. It's wonderful to have some backup food so that I don't need to depend on takeout for nourishment. Here, for your reading pleasure, is my meal plan for week #7.

Saturday: Pork Pie with Oka Mash (from Canadian Living). Yum, yum, yum.
Sunday: Short Ribs with Mushrooms and Red Wine Sauce (also from Canadian Living). I'm trying something fancier than usual, as my mom is coming for dinner.
Monday, Tuesday, Thursday, Friday: Leftovers!
Wednesday: Birthday dinner (not mine) with friends at a local Asian fusion restaurant.

The pork pie involved a lot of peeling and chopping and sauteing and baking, but it was definitely worth it in the end. Way tastier than standard shepherd's pie. I made it with smoked gouda instead of oka cheese, as my regular grocery store doesn't carry oka cheese, and I was not willing to drive half an hour to go to a store that does. I think it was a perfectly acceptable substitute.

Everything else on the "To Do" list is going to have to wait, as my brain and my body are both in need of some recharging. Rather than tackling my pile of dictations or heading to the mall (ahhhhhhh) to shop for Christmas gifts, I'm going to watch the Big Bang Theory and eat dessert.

Here's hoping that there are no hepatological emergencies tonight and that everyone is enjoying their weekend as much as I am. This is definitely a day that I'm not going to wish away.

Unexpected

2011-12-09T23:46:00.003-06:00

I'm currently eight days into a thirteen-day-long hepatology elective. When I was signing up for electives at the beginning of the year, hepatology was near the bottom of my list, something I ranked at all only because I'd heard the teaching was good and because it sounded far less boring than many of the other choices. (I'm looking at you geriatrics. And allergy and immunology.) When I saw that I'd gotten hepatology instead of some of my higher-ranked choices, I was a bit disappointed, but I didn't think too much of it. I figured it would be a good chance to brush up on my approach to liver enzymes, and the slower pace would be a nice break after two long weeks of night float.

I had no idea how much I'd enjoy it.

The patients we see on consults are far more complex and interesting than the straightforward alcoholic/viral/autoimmune hepatitis patients that internal medicine routinely manages on the wards. They often have multiple processes contributing to their liver disease, such as accelerated cirrhosis from hepatitis B and D co-infection, or from ongoing alcohol use on top of chronic hepatitis C infection. Or they have multiple complications of their liver disease that make treatment challenging, such as a patient whose blood is clotting too much, causing clot formation in his portal vein, but simultaneously not enough, causing him to ooze blood from his iv sites. The complexities of the field are far more exciting to me than I expected.

What I'm enjoying even more though are the social issues that come to the forefront in hepatology. I've always had a strong interest in how factors outside of the healthcare system, the so-called "determinants of health", influence a person's health and well being, and I'm reminded of the centrality of these factors to health in my weekly viral hepatology clinic. Most of the clinic patients are hepatitis B-positive, usually as a result of being born in an endemic region where crowded living conditions and lack of access to healthcare perpetuate the spread of disease. And now that they've emigrated to Canada, their ability to access appropriate care is impaired by their lack of understanding of the system and the fact that they speak a different language from the healthcare providers. (Note to self, learn to speak at least rudimentary Tagalog.) The remainder of the clinic patients are hepatitis C-positive, usually as a result of either brief experimentation with iv drugs at a time when hepatitis C was common in North America or long-term heavy iv drug use. As I read through Gabor Mate's In the Realm of Hungry Ghosts, I'm reminded of the many societal, familial, and personal factors that lead a person into drug use and, unfortunately, to complications such as hepatitis C.

Reflecting on my brief stint in hepatology, I'm realizing that it has many of the things I'm looking for in a career. Intellectual challenges. A patient population that I enjoy working with. Opportunities to influence healthcare policy and systems on a larger scale. I'm enjoying it so much that the wheels are turning in my head, pondering whether this is something I could do long-term. It's a bit of a shock to me to be in this position, as this is the first time in residency that something other than oncology or hematology has really caught my interest and made me question the path I'm on.

Ironically, I officially started telling people that I'm going to apply for an oncology fellowship about two weeks ago.

Ah...isn't life interesting? If nothing else, it keeps us on our toes with its never ending twists.

Anticipation

2011-12-07T22:07:00.002-06:00

I am happy to report that, minutes after publishing my previous post, I crawled into bed and slept uninterrupted for 10 hours. It was glorious. I awoke the next day feeling somewhat alert and capable of intelligent thought for the first time since I finished night float. It's amazing the difference that rest makes.

Despite getting somewhat caught up on sleep, I'm still eagerly awaiting my next day off (currently 9 days away). Every morning I do a quick tally in my head, counting up the days behind me and the slowly diminishing number of days to come. And I long for it to go faster so that I can have a day without alarm clocks or patients or attendings or piles of charts to dictate.

Recently, it got me thinking to the fact that I spend a lot of my time longing for time to go faster. During the week, I long for the weekend. During a rotation that I'm not enjoying, I long for it to be over and the next one to start. And I'm always longing for vacation, which at the moment is almost 3 months away. I'm always looking ahead, always wanting to be through with the current moment so that I can move on to something better. And in the process, I seem to be wishing my life away.

I don't know if there's any way to stop this. I want to be more present in the moment, to appreciate the things that I'm doing now, but it seems to be human nature to always long for something better. It doesn't help that I seem to always be tired, and stressed, and overwhelmed. Days off are like tiny islands of calm within the turbulent sea that is residency, so I suppose it's not surprising that I'm always wishing for one. But I wish sometimes that it didn't have to be this way.

---

Now that I'm somewhat more rested, I've been trying to stick to my December goal of limiting my electronic media to 1 1/2 hours per day. And I've been failing miserably. I tend to read blogs in the morning while eating breakfast, to watch tv while eating supper, and to watch tv/read blogs/write blog posts at the end of the day as a way of destressing, all of which adds up to more than 1 1/2 hours. I debated stubbornly pushing ahead with my goal, but I realized that doing so wouldn't free up that much extra time, as most of my electronic media time overlaps with things that I have to do anyway. So, in the interest of my own happiness, I'm abandoning that aspect of my December goal. I am, however, sticking with what I think is the more important aspect of my goal - to stop checking emails/Facebook/blog stats while doing other things (like studying). I think I lose a lot of efficiency and waste a lot of time by frequently interrupting my studying, so I'm hopeful that this will help.

Aaaand....I seem to be losing all capacity for intelligent thought as the sleepiness hits me once again. Time to watch the end of Project Runway (no intelligent thought required), pack some of my leftovers for tomorrow's lunch, and then go to bed.

Consistency

2011-12-05T21:25:00.000-06:00

Today marks the fifth evening in a row that I've fallen asleep on my couch, and the third night in a row that I've done it in front of Parenthood. Either I'm really tired or the show is really bad. I wouldn't know, as I'm usually out before Bob Dylan starts singing the theme song.

More interesting and coherent posts to come when I get caught up on sleep. See you all around Christmas.

What Meal Plan?

2011-12-03T22:05:00.001-06:00

Normally I can handle tired. After all, a person doesn't make it to their second year of residency without learning how to push through sleep deprivation. But the post-night float tired is a completely different beast from ordinary tired. When making the transition back to a normal sleep schedule, my body, having become fully accustomed to sleeping during the day, will simply ignore the will of my conscious mind and fall asleep whenever there's a lull in activity. During a talk on airway management. While waiting for dinner to heat up in the microwave. Five minutes into the recently downloaded pilot of Parenthood. The last two days have been about the closest thing to narcolepsy that I'll (hopefully) ever experience.

As a result of this nearly irresistible urge to sleep, I haven't kept up with any of my goals. My lovely and not overly ambitious meal plan for the week has given way to dinner out with my mom, McDonald's, and takeout from a local Italian market. I have probably kept to my 1 1/2 hour per day limit on tv and internet, but only because I fall asleep whenever I try to do either. If sleeping in front of the tv counts, I'm definitely over. I hate this. I want to be able to follow through on the goals I set for myself, or at least be conscious to enjoy some of my free time this weekend. Grumble, grumble, grumble.

Ah well...this will be over soon. By the end of the week, I'll be sleeping at night and awake during the day like a normal person. Hopefully then I'll be able to cook myself real food and open a textbook without inadvertently using it as a pillow. And write a real blog post - I have dozens of half-composed posts on interesting (to me at least) subjects bouncing around in my head, but I haven't the mental focus to get any of them down. In particular, I started reading Gabor Mate's In the Realm of Hungry Ghosts while awake during the night last weekend, and it has me ruminating on issues of addiction, resource allocation in medicine, social justice, and others. Hopefully some of these thoughts will make it onto the screen before too long. (Of course, I also have about four posts in my brain that stemmed from the Women In Medicine evening I attended over a month ago, so these new posts may not see the light of the internet until the new year.)

How is everyone out there in cyberspace doing? Still bearing with me despite my recent posts in which I use a lot of words to basically just say "I'm tired and grouchy"?

This Day Brought To You By Caffeine

2011-12-02T06:41:00.001-06:00

As excited as I am to be done night float, I hate the transition back to a normal sleep schedule. Being a recalcitrant insomniac means that I don't adjust well to changes in my sleep schedule, and as I've said here before there's no bigger adjustment than switching from days to nights. Having worked night float gives me a whole new level of respect for nurses and other people who work shift work on a regular basis. I'm very glad it's you/them and not me who does this all the time.

Yesterday I had the brilliant idea to sleep less during the day in the hope that I would sleep more during the night. Not so much. I got about 3 hours of sleep during the day and then spent my evening in a grouchy fog, trying to be a civil daughter to my Mom who had driven into the city to visit me. I put on a decent show, but internally I was annoyed by things that normally wouldn't phase me - the poor service and loud music at the restaurant we went to, my Mom's perfectly reasonable request to look something up on my computer, my Mom's lack of interest in Tuesday night's Glee episode. I was just cranky.

Going to bed, I initially did well thanks to utter exhaustion and a few sublingual melatonin pills. But after about 4 hours of sleep, I was wide awake with no hope of drifting back into dreamland. I lay in bed for a full three hours, hoping that by "calming my mind" and giving it time I would eventually fall back asleep, but it wasn't happening. So here I am, a full 1 1/2 hours before I need to wake up, writing a blog post. As much as I enjoy blogging, I would definitely rather be sleeping.

Looking forward to the next few weeks just makes me even grumpier. This weekend is a two-day mandatory ICU course, which doesn't count as a "work weekend", so I'm on call the following weekend as well without being in violation of the call limits of our contract. And then the weekend after that is part of the next rotation (and therefore next set of call limits), so guess what? I'm on call. Yep...coming off of nights, I'm now working a 21-day stretch with only one day off before Christmas. Grump, grump, grump...

I will get through this, but it's going to hurt. I hate the fact that mandatory exams and educational sessions don't count as "working weekends". As a result of this loophole, I haven't had a weekend off except when I've been on night float since I got back from holidays in September. And I still won't have a weekend off until the five days of Christmas holidays, when I will do my best to drink enough caffeinated beverages to be pleasant around my family.

Anyway...I have nothing more profound to say than that I'm not looking forward to this stretch and that sometimes I hate the demands that are placed on us as residents. I understand fully that I signed up for a demanding career path and that this is just part of what is required of me, but I don't think I'm being unreasonable by wanting some time to sleep. Or at least free Starbucks gift cards as a bonus for having a stupid call schedule.

Edited to add: Knot Telling - one of my newer commenters and someone whose blog I read regularly - wrote a post inspired by my recent post about my pigeons of discontent. It's a great post about becoming happy despite one's life circumstances, and I strongly suggest reading it and dropping her a quick comment on it.

On reflection, it's kind of ironic that I wrote a post recently about being fundamentally happy, while today I'm writing a grouchy post about working too much. Apparently being fundamentally happy doesn't fully protect a person from the ups and downs of life (or of their inner psyche).

Dedicated Snacking

2011-12-01T06:15:00.005-06:00

3 am on night float (last one!):

Thought: "I feel like chips. Salt and vinegar kettle chips...mmmmm. But I still haven't been to the bank, and I've exhausted the supply of loose change at the bottom of my school bag."
Walk from 6th floor internal medicine ward to residents' room on 5th floor to get bank card.
Walk from residents' room on 5th floor to bank machine on 1st floor.
Take out $20 bill.
Walk back to 5th floor vending machine. Discover that there are only Sun Chips and Smarties in vending machine. Disappointment!
Remember that there is a vending machine on the 1st floor. Right next to the bank machine.
Walk back to the 1st floor vending machine. Discover that there are only Sun Chips, Old Dutch potato chips, and Hershey's chocolate bars. Feel sense of despair.
Remember that there is a vending machine on the 3rd floor next to labour and delivery.
Walk to the 3rd floor vending machine. Discover salt and vinegar kettle chips. Success!
Discover that 3rd floor vending machine does not take bills. Contemplate kicking in glass of vending machine out of desperation.
Remember that there is a drink machine on the 1st floor that takes bills and gives coins as change. Hatch a new plan!
Walk back to the 1st floor and visit the drink machine. Discover that it only takes $5 and $10 bills. Suspect that the universe is mocking you.
Walk back to the 5th floor vending machine and discover that it takes $20 bills. Yay! Buy a box of Smarties to hide in your backpack for a future date and cradle the precious change in your hand.
Walk back to the 3rd floor vending machine and buy the hard-earned salt and vinegar kettle chips. Success!
Walk back to the residents' room on the 5th floor. Gleefully crack open the bag, anticipating your first bite of salty, sour, crunchy goodness.
Curse the universe when you're paged stat overhead to a code before you get to eat a single chip. Defiantly shove three chips into your mouth and try not to choke while running down the stairs to the code.
Try not to think about chips while giving orders for resuscitation.
Drag self wearily back to residents' room after code.
Gaze lovingly at chips.
Finally eat chips.
Realize you weren't actually craving chips, you were just bored.
Realize that you're still bored.
Eat Smarties.

Pigeons

2011-11-30T09:53:00.000-06:00

This morning my blog idol Sarah (SHU) wrote a post about her pigeons of discontent. "Pigeons of discontent", a term coined by Gretchen Rubin at the Happiness Project, are ordinary problems that have "settled in to roost" and that interfere with our ability to be happy. After reading Sarah's and Gretchen's blog posts, I thought about my own pigeons of discontent and initially came up with a nice long list.

Not enough exercise
Not enough sleep
Not enough studying
Too much time with electronic devices (see December goal)
Too wasteful with my money
Etc.
Etc.
Etc.

I could go on. But as I thought about it, I realized that despite having a long list of potential self improvement projects, I am fundamentally happy. Not all the time, certainly not at 4 am on a night float shift when I want to toss my pager into the fires of Mordor, but overall I'm happy. And with very good reason. Balancing out my list of pigeons of discontent is a very long list of things to be happy about.

A job that I love (overall, and not at 4 am)
Good health
Wonderful family and friends
A long list of amazing life experiences that will hopefully keep getting longer
Etc.
Etc.
Etc.

I could go on again. But I won't, given that I was supposed to be sleeping an hour ago and my brain is slowly melting into post-night float goo. My very simple point is that, as much as I'd like to keep working on making life better, it's important for me to recognize that things are already very good. Everything that I'm considering for future goals - more exercise, more studying, fewer $5 Starbucks lattes - isn't a fundamental change that's necessary to my happiness, but rather just a tweaking. And that's a pretty good place to be in life.

(All that being said, I reserve the right to moan and complain about my life as much as I want in the future.)

(I also would like to request that the universe not view this as a taunt or a challenge to make my life miserable. The last time I made similar comments was just a few months before my Dad was diagnosed with cancer, so I would like to request that the universe give me a break and allow me my moment of happiness this time.)

Dear Universe

2011-11-29T03:18:00.000-06:00

I apologize for opening my ICU textbook and trying to read. Clearly, I taunted you by thinking that I might actually have a slow night and be able to get some stuff done. But did you really have to punish me by making everything go wrong at the same time? Two codes in one evening is intense - but two codes simultaneously? Really?

I'm sorry that I angered you so. From now on I will quietly play Angry Birds in the call room when things aren't busy so as not to attract attention to myself.

Sincerely,
Solitary Diner

(I am soooo done with night float.)

Soup, A Duo

2011-11-27T20:11:00.005-06:00

This is what it looks like outside my window right now. (Well, technically what it looked like in front of my brother's house yesterday morning, but things haven't changed much.)

When winter hits, I start craving soup. Warm, flavourful, comforting. Mmmmm. I've recently made mention of two of my favourite soup recipes - sweet potato soup and tortilla soup - and thought I'd share them here. I strongly recommend trying both of them. They're easy to make, they taste amazing, and they freeze beautifully. On days when I'm too lazy to cook (i.e. most days), it's wonderful to just grab a bowl of soup from the freezer and be done with supper. Or even better to come home to the smell of fresh tortilla soup cooking in the slow cooker.

Now I'm drooling. Hope you enjoy these.

Soup #1 - Sweet Potato Soup (From the Sundays At Moosewood Restaurant Cookbook):

Ingredients:

2 cups chopped onions
1 tablespoon peanut or vegetable oil
1/2 teaspoon cayenne pepper
1 teaspoon grated peeled fresh ginger root
1 cup chopped carrots
2 cups chopped sweet potatoes*
4 cups vegetable stock or water (I use chicken stock unless I'm making it for a vegetarian.)
2 cups tomato juice (I use vegetable coctail)
1 cup smooth peanut butter
1 tablespoon sugar (optional)
1 cup chopped scallions or chives (I leave these out.)

Saute the onions in the oil until translucent. Add the cayenne pepper, ginger root, and carrots and saute for a few more minutes. Add the sweet potatoes and water or stock and simmer until tender (at least 15 minutes).

Transfer the vegetables, stock, and tomato juice to a blender and blend until smooth. (You could try an immersion blender for this, but the soup is better if it's really smooth, so I think it's worth the time to transfer it to a blender.) Return the soup to the pan, add the peanut butter, and heat gently until warm. Add sugar if desired. Serve as is (my preference) or topped with scallions or chives.

Mmmmm.

Edited to add: I just finished making tonight's batch of this using natural peanut butter (i.e no sugar, salt, or emulsifier) instead of "regular" peanut butter, and I like the taste much better. It has less of a cloying flavour, and the flavour of the vegetables comes through much better. I would recommend giving it a try. You may have to give it a bit of extra salt to make up for the salt in the peanut butter.

* The terms "sweet potato" and "yam" are often interchanged (particularly up here in Canada), so for clarity this soup uses the orange, sweet tuber rather than the yellow, less sweet tuber.

Soup #2 - Tortilla Soup (Original recipe from my friend the Psychiatrist. Has been modified many times by me to yield my preferred version.)

Ingredients:

1 pound raw boneless chicken (I use chicken breasts, but I think any boneless chicken would work. I will often use as little as 1/2 a pound, as I like my soup to have a lot of broth.)
15 ounce can diced tomatoes
10 ounce can enchilada sauce
1 medium onion, chopped
4 ounce can chopped green chile peppers
2 cloves garlic, minced
2, 14.5 ounce cans condensed chicken broth
14.5 ounce can water
1 teaspoon cumin
1 teaspoon chili powder
1/4 teaspoon black pepper
10 ounce package frozen corn (optional)

Place all of the ingredients in a slow cooker and mix well. Cook on Low setting for 6 to 8 hours (or however long you're at work) or on High setting for 3 to 4 hours. Remove the chicken from the slow cooker, shred, and return to soup. Serve topped with your choice of crushed tortilla chips, avocado, grated or crumbled cheese, and/or sour cream.

Mmmmm....so easy, yet so tasty.

Re-emergence

2011-11-27T01:08:00.002-06:00

I was halfway through my third year of medical school when I found out that my Dad had melanoma. He had felt well up until the day he discovered a mass of enlarged lymph nodes in his right armpit, and then within a matter of weeks we learned that he was dying. Never before, and so far never since, has my life been thrown off balance so suddenly or to such an extreme.

A few weeks after the diagnosis, my Dad and I sat in front of a flickering candle and a rapidly diminishing bottle of wine, talking late into the night about many different things. We didn't talk much about the diagnosis itself - it was still too fresh a hurt to really acknowledge - but we talked about how I was doing with "things" and how I was "holding up". I distinctly remember my Dad telling me that one of his greatest fears was that his disease would derail me from my studies and keep me from finishing my medical degree on time. He didn't say it out loud, but I'm sure he had an even deeper fear that his death might be enough to throw me off my path entirely and prevent me from ever finishing.

During that conversation, I promised my Dad in no uncertain terms that I would finish my degree, and that I would do so with my classmates. At the same time, I gave myself permission to make whatever concessions were necessary to keep that promise. My personal health, fiscal responsibility, a clean apartment - all of these things and others could be sacrificed in the interest of just getting through. For the seven months until my Dad died, and for almost two years afterwards, I lived in survival mode, doing only what was necessary to get through medical school and then residency.

Things suffered as a result. My pant size has increased in parallel to my dependency on fast food establishments to feed me. My student loan...ugh...that's all I really need to say. (Fast food isn't cheap.) The only thing keeping my apartment from descending into absolute squalor is a housekeeper who visits regularly and does the work for me. I haven't been taking care of my life in the way I've wanted to, but I did keep my promise.

There comes a time, however, when self preservation becomes an excuse rather than a necessity. I don't live in the midst of crisis or turbulent change anymore. My life, for now at least, is relatively stable. As busy and demanding as residency may be, I still have energy and mental reserves to do more than just get through. So slowly, slowly, I'm trying once again to focus on all the things that I've neglected over the past almost three years.

At the beginning of November, I wrote a post about goal-setting and about gradually making changes to move towards where one wants to be in life. My November goal was to start meal planning, and despite being a bit thrown off by the chaos of night float, it turned out really well. In the past month, I've had very little fast food and have brought almost all of my meals to work. I've made multiple home-cooked meals and discovered that it actually isn't that hard to cook during residency. (Except during night float.) And I can only imagine how much money I've saved over the last month by not being dependent on other people to cook for me. It's been a very positive change, and one that I plan to continue going forward.

If you're interested, here's week five of meal planning. (Week four never quite made it onto the blog due to the busyness of night float, but I did write a meal plan and follow it somewhat.)

Saturday: Dinner (sushi) with A. Cook more sweet potato soup for the freezer. (Previous batch having already been eaten. Mmmmm.)
Sunday: Chicken curry.
Monday - Wednesday: Leftovers. (I'm finishing up night float and have realized that I will not cook after a 14-hour night shift.)
Thursday: Sesame-soy meatballs with rice.
Friday: Tortilla soup. (Crockpot recipe that will cook while I work.)

As for December, my goal is to free up more time for important things. I want to have some time to destress every day, but lately I've allowed my destressing time to balloon out far more than it should. So for December, my goal is to spend no more than an hour and a half per day with electronic forms of entertainment (tv, internet, this blog). That still seems like a ridiculously long amount of time, but sadly it's less than I've been spending lately. I need to exercise a bit of self discipline when it comes to time killers like Facebook and internet surfing. Along the same lines, I'm also committing to not letting my online activities spill over into my other tasks. I have a bad habit of checking email/Facebook/blog comments while I'm trying to study, and I'm going to work on stopping this. I need to start making better use of my study time so that I can do more than just "get by" during my residency.

The Weekend

2011-11-26T05:46:00.001-06:00

Snow is falling outside, keeping people away from the emergency room and my pager silent (for now, at least). In some ways the waiting is the worst - not knowing if or when I'm going to get summoned from my semi-comfortable call room to go back to work. Regardless of what happens, I'll be leaving in just over three hours, so I'm happy. Almost time to relax.

After my previous post in which I lamented not seeing more of my family, it occurred to me that I should probably just do something about that, so I invited myself to a post-night shift breakfast at my brother's house this morning. Homemade quiche, decaf coffee, and two giggling redheads sounds like the perfect end to my "day". In the evening, I'm off to visit with my friend A, who is doing well enough that she has a weekend pass away from the hospital. Here's hoping that this is the beginning of good things for her.

Being on night float always makes me feel a bit sorry for myself. It stresses me out to be the person in charge; I hate being awake when everyone is asleep and asleep when everyone is awake; and I miss having time in my day for things outside of work. But when I look around me at all the patients who don't get to leave, I realize that I really don't have much to complain about.

Holiday Dread

2011-11-24T21:59:00.000-06:00

Hey look...I have free time at work! (So far. Universe, please don't smite me by taking away my delightfully wonderful free time. I've had enough of the smiting lately.) Am I using this free time to read the ICU textbook I talked about in my last post? Umm.....no.... but I will get to it after getting a few thoughts down here.

At about this time every year, I start to get a bit twitchy about the rapid approach of Christmas. It's not that I dislike Christmas - even atheists enjoy time off from work, pretty lights, and free reign to eat as much unhealthy food as you want - it's that I abhor Christmas shopping. I hate spending half an hour driving through a parking lot in search of the elusive empty spot. I hate the crowds of people abandoning all social graces as they elbow each other to get at the latest "Made in China" plastic doohickey. I hate feeling like my love for the people in my life is going to be measured by how good a gift I manage to find them. And I hate that I'm adding to the bazillion dollars of debt that I already have buying items that will be tossed in my nieces' overflowing toy room, never to be seen again.

If I had my wish, I wouldn't buy any Christmas gifts. Instead, I would take the time that would otherwise be spent in the mall and spend it with my family and friends. I would take my nieces to the Muppet Movie (you know, for their enjoyment....not mine....noooo....I'm a grown adult...I definitely have no desire to see the Muppet Movie and would be doing it purely because I am a self-sacrificing aunt who will stop at nothing to make her nieces happy). I would spend the night at my Mom's house and watch cheesy movies in bed with her while getting buttery popcorn all over her clean sheets. I'd have my friends over to my apartment for egg nog and Christmas tree decorating and put so much rum in the egg nog that the tree would qualify as modern art. All of these things sound infinitely better than tripping a mother in Toys R Us to get my hands on the last of the hottest new kids toy before she does.

Unfortunately, despite pleas to give up on gifts, I've been told in no uncertain terms that I am expected to participate in the family gift exchange. Well, actually I've been told that everyone else will be buying gifts for me, and only a Grinch wouldn't buy gifts in return. So off I will go to the mall, and I will participate in my annual ritual of desperation as I run from store to store trying to find something meaningful for the people I love. Can't wait.

---

On a related note, what actually prompted me to start writing this post was my realization that tomorrow is Buy Nothing Day. Buy Nothing Day was started 20 years ago by a group of Vancouverites called the AdBusters, and it encourages people to not make any purchases on that day as a means of reflecting on the rampant consumerism of our society. (The choice of Black Friday was entirely intentional.) I have participated in it every year that I've remembered (which sadly isn't that many), as I think it's important to periodically step back from our consuming and reflect on whether it's really contributing to our well-being. Just putting this out there....feel free to participate if you like or to think about what a crazy, granola-eating, tree-hugging hippy I must be while you're camped out in your tent waiting to be the first person in Walmart on Black Friday.

---

P.S. I apologize for being so delinquent with replying to comments lately, but my internet decided it didn't like me anymore. The problem has now been fixed, and I will try to get caught up in the next few days.

Alright...now for that ICU book.

Grumble, Grumble.

2011-11-24T00:21:00.002-06:00

Yesterday was one of those days.

It started with discovering that my internet was down and unresponsive to my limited attempts at repair (i.e. restarting the computer and the router), necessitating an in-home service visit for tomorrow afternoon. For while I'm supposed to be sleeping.

Then I couldn't sleep. I was wired when I got home from the previous night's shift and spent over an hour ceiling-gazing before finally dozing off. After about 4 hours of sleep, the cats decided I'd had enough and started alternately poking me in the face, yowling by the empty food dishes, and zooming around the apartment at full speed. Apparently it was time for me to get up.

Then I left my pager at home when I headed out to my night shift. And my dinner in my schoolbag when I got to work. By the time I took a supper break eight hours later, I wasn't willing to risk eating the room-temperature pork roast that had been lovingly packaged for me by a family friend, so I was forced to subsist on the few non-perishable items in my bag. Motts applesauce and a granola bar just weren't enough to keep my stomach from rumbling like mad until the cafeteria opened at 7 am and I could get real food.

Initially, today was looking like a much better day. I managed to get 7 hours of restorative sleep, nothing was left at home when I headed to work, and my tasty dinner (which I'm eating while typing this) made it into the fridge. The emergency room was a five-letter word that starts with "q" that no one dares utter while on call, so I was optimistic that I might get to open the ICU training course textbook that I need to finish in the next 1 1/2 weeks. And then, moments after I sat down in the residents' lounge and cracked the spine on my textbook, the call came.

Very ill-sounding voice: "Solitary? This is the medical student on call. I'm not sure I should be going into patient rooms. I'm feeling kind of sick."

SD: "How sick are you?" (Yes, I'm that asshole.)

Med student: "Well, I'm feeling kind of unsteady on my feet, and I'm a little dizzy. The nurse just measured my temperature at 38.9 C." (102 F)

SD: (Long pause while staring longingly at page one of the textbook.) "Go home. I'll cover for you."

Med student (sounding slightly perkier): "Are you sure? I could take some Tylenol to bring the fever down. And the nurse has offered me some Gravol for the nausea."

SD: (Shorter pause while contemplating the ethics of sending a sick medical student in to examine a febrile neutropenic patient.): "Go home."

In the grand scheme of things, having to be a ward intern for a night is a ridiculously small deal. But I'm still in a crotchety mood. I may need a full sugar Coke tonight.

Happiness on Night Float

2011-11-22T02:44:00.000-06:00

...is discovering that you have enough change for a bottle of Coke Zero.

Double happiness is finding a misplaced Halloween-sized box of Smarties in the process of searching for said change.

Mmmmmm.

A Slightly Rambling Middle of the Night Post

2011-11-21T07:05:00.003-06:00

Last night, I spent many middle of the night hours awake and alone in my apartment in an attempt to maintain my night float sleep schedule over the weekend. I'm not very good at being productive during the night, so I spent a lot of that time probing the depths of my PVR for something worthwhile to watch. In amongst multiple Food Network shows and Big Bang Theory reruns, I stumbled across an episode of the Nature of Things that I'd impulsively recorded because it had a medical bent. (And because I love the narrator, David Suzuki, who is Canada's version of Morgan Freeman.)

The episode features Gabor Mate, a Vancouver physician who works with addicts in his city's Downtown Eastside. For anyone not familiar with Vancouver, the Downtown Eastside is an area that is affected by social issues, particularly drug abuse, to an unprecedented degree. On my first visit to Vancouver, I inadvertently ended up on a bus that went through the area, and I was shocked and appalled at the magnitude of human suffering that I witnessed just in passing through. Words fail me, so for a better understanding of life in the area, I would suggest watching even just the first few minutes of the Nature of Things episode (available here).

What struck me about the episode was Dr. Mate's concept of addiction. Early on, he describes addiction as a response to emotional pain and states that one must understand and address that emotional pain in order to overcome addiction. In his words: "The salient question in addiction is always, not 'Why the addiction?' but 'Why the pain?'."

In his work with addicts, Dr. Mate uses traditional South American medicines and ceremonies to help them remember and work through the emotional trauma and pain that they've experienced in their lives. Key to doing this is learning to be present in painful situations and to experience them rather than trying to escape them through addiction. Near the end of the episode, Dr. Mate asked a question of one of his patients that has stuck with me and been milling around in my brain ever since: "The question is, can you be with your own pain? Can you be with your sadness?"

Dr. Mate's question resonated with me for many reasons, one of which is the relevance of his question to my thoughts on palliative care, which I started to address in my post from two nights ago. I realized early on in my training that to talk with a patient who is dying - to really talk with them on more than a superficial level - requires being able to "be" with the patient's pain and sadness. But what I'm learning as I go on is that this also requires the physician to "be" with his or her own pain and sadness. Bearing witness to people dying is painful, as it's a reminder of our our own vulnerabilities and of the inevitability of suffering in life. Part of the reason we, as doctors, don't always talk to patients about prognosis and palliation is because it brings up our own pain, and we aren't always able to deal with that.

Hmmm...I feel like this is a post that needs to simmer a bit before I publish it, but I also know that it'll sit unpublished until next weekend if I don't do it now. (Working 14 hour shifts isn't conducive to writing serious blog posts.) So here are my middle of the night thoughts, mostly unedited. It's almost morning now, so clearly it's time for me to go to sleep.

The Dying Process

2011-11-19T23:39:00.002-06:00

Last night I got slammed. There were crises on both wards, a seemingly endless list of patients to screen for admission to Medicine, and angry emergency room doctors pestering me about why I hadn't seen their patients yet. (You know, because I'd been sitting in my call room eating crumpets and tea all evening.)

I loved it. As much as I wish for quiet nights and dread the sound of my pager going off, I actually prefer the busy nights. I love the sound of my hurried footsteps echoing through empty hospital corridors, the slashes through completed tasks on my to-do list, the TBADM (to be admitted direct to medicine) icon that appears on the EPR every time I admit another patient. I'm always stressed at the beginning of a busy night, worried that I'm not fast enough or competent enough to complete everything, but I quickly settle into my groove and start enjoying myself. There's an incomparable satisfaction that comes from doing the work that you've devoted your life to doing.

Towards the end of the night, as I was entering the orders for my last patient and starting to mentally wind down, I got a desperate page from one of the wards about a patient who was crashing. She was "no codes", so there would be no ICU team to help. This one was entirely on me. My heart and my mind raced as I yelled orders into the phone and then ran up to the ward to lay eyes on the patient. "Airway, breathing, circulation. Airway, breathing, circulation." I repeated these words in my head like a mantra as I ran up the stairs, reminding myself of the algorithms and the processes that guide emergent care.

In the stairwell, mere steps from the ward, I suddenly remembered why the patient's name had sounded so familiar to me. I had seen her previously on a consult service and had been horrified by the severity of disease on her CT scans. The only reason she hadn't been made palliative at the time of diagnosis was the suddenness of it, the need for time to process and come to some degree of acceptance. Entering the room, seeing how sick the patient had become, hearing the screaming of multiple alarms fighting with each other for attention, it became clear that there wasn't any more time.

I'm usually slow to make decisions, taking time to weigh the options and ensure that no detail has been overlooked. I like to think it makes me a good resident, although some might argue that it just makes me slow. But in this situation, there was no deliberation. My role in this situation wasn't to examine or investigate or intervene - it was to ease the passage out of life as much as I possibly could. Orders were placed for morphine and scopolamine, family was called, and the transition to comfort care was made. There was a palpable change in the patient and the atmosphere around her after the decision was made - from panic to calm, almost instantly.

If there's one thing I've come to believe fiercely in over my time in medicine, it's aggressive palliation. I've been witness to many deaths in my training - both good and bad - and there are few things worse than a death that involves unnecessary pain and physical suffering. The worst part of it is that it is often us, the providers of care, who are responsible for not palliating dying patients soon enough or well enough. We're often unwilling to recognize the point at which we run out of options for curing a disease or extending life, as doing so is admitting failure, acknowledging that despite all of our tests and machines and iv bags filled with magic potions we are still limited in what we can do. Even when we acknowledge this reality, we often avoid having the difficult conversations with patients and their families because they make us uncomfortable. And our patients suffer as a result of our cowardice.

When my Dad was diagnosed with melanoma, one of his biggest fears was of the process of dying itself. He had had a lifelong fear of drowning, and he was terrified of gasping for air from the tumours in his lungs. Fortunately, he had a fabulous oncologist who was involved in pain and symptom control who ensured that he rarely suffered physically. And he had two children in medicine, both ardent supporters of palliative medicine, who assured him that he was always in control of his treatment and that we would do everything possible to keep him from suffering. Having seen the difference that this made in the dying process for my Dad, I view it as somewhat of a personal mission to ensure that all of my patients receive this same level of care. While I can't save everyone from dying, I can make the process as bearable as possible.

It's Possible That I Was Tired

2011-11-18T17:03:00.003-06:00

After my lovely breakfast out yesterday, I came home and decided to have a "quick" nap. Fortunately I set the alarm, as I fell into a dead sleep from which I didn't awake until it went off at 3:30 PM.

My night at work was ridiculously slow, with only one consult and two admissions to review with the medical student, so I made it to the call room by 11:30 PM. Although I initially couldn't sleep because of my long afternoon nap, I eventually fell asleep from about 2 am until 7:30 am.

Coming home today, I wasn't entirely certain what to do with myself, as I'd already gotten essentially a full night's sleep between my afternoon nap and my time in the call room. But I was starting to doze on the couch by about 10 am, so I decided to head to bed - where I slept for 6 more hours. For anyone who's interested, that's approximately 15 1/2 hours of sleep in just over a day.

Ahhhhh....the single biggest thing that I dislike about being a resident is not getting enough sleep. But when I do finally manage to get (somewhat) caught up, I feel like a million bucks. If tonight is another slow night (which is entirely possible thanks to a backlog of patients in the emergency room), I may actually have the energy to do something productive. Like emailing fellowship program directors.

Solitary Breakfasts

2011-11-17T11:08:00.004-06:00

It’s 9:30 am, and I’m sitting alone in my favourite neighbourhood café awaiting the arrival of “the usual” – a café breakfast with two eggs over medium, bacon, and sourdough toast. Mmmmm. I hate to think about how much money I’ve spent in this place over the years – it was my favourite study place during my pre-clerkship med school days, and it’s become my go-to restaurant when I’m post-call or am too tired to cook but don’t want takeout. The food is consistently good, the atmosphere is relaxed, and the person who selects the music that plays overhead is pure genius.

At least 90% of the time, I eat here by myself. In the beginning, this used to embarrass me. I would slink into line with all the groups of people awaiting tables and quietly mutter “just one” when asked how many people were in my party. Once I was seated, I would pull out a textbook and start scribbling notes in the hope that anyone watching would think that I was alone only because I was too busy to socialize with my myriad of friends. I didn’t like being the person who was eating alone, and I liked the thought that other people were observing my aloneness and judging me for it even less.

But slowly, my thoughts have changed. Over time, I’ve come to appreciate the unique pleasure of eating alone, particularly in a restaurant in which the wait staff treat me well despite being just one person at a table for two. It’s nice to be able to eat at my own pace, undistracted from the great food by conversation that I may or may not be interested in. I enjoy spreading a newspaper across the entire table and slowly flipping through every page (except the sports section). This time by myself – free from textbooks or other obligations – has become my much cherished escape from the business of life.

And clearly I’m not alone in being alone. Looking around, there are at least five other people eating by themselves in my favourite café. Apparently I’m a trend setter.

---

If you’re wondering why I’m having breakfast at this time of day instead of being immersed in work on the TB ward, it’s because today is the transition day between my Chest Medicine rotation and my two weeks of night shifts. Thanks to a recent bout of intractable insomnia, I’m starting this two week period already tired, which is not a good thing. I avoided coffee this morning in the hope that I will be able to nap in the afternoon, but I have a feeling that tonight is going to be a brutal shift regardless. Am I a bad person for hoping that all of the people visiting the emergency room tonight will need to go to surgery instead of medicine?

Musings on Lewis Carroll

2011-11-15T21:05:00.002-06:00

Everything about visiting A in the hospital feels wrong.

When I first arrive, it's as if I'm there for an evening call shift. Although it's a non-teaching hospital, A's hospital has all the components of the hospitals where I usually work - doctors in scrubs and white coats rushing through the corridors, coloured lines on the floors directing visitors through the maze of hallways, the faint whiff of bodily fluids that is almost, but not quite, masked by the much stronger odour of antiseptic. When we sit in the cafeteria and she asks about my day, it feels no different from nights when we've been on call at the same time and have met for a few brief moments to grab food and exchange horror stories about our work.

But underneath the surface, everything is different. The differences are subtle enough that I can ignore them for minutes at a time, but then a glimpse of the iv in her hand or of the hospital bracelet on her wrist brings me instantly back to the reality of the situation. And when we talk about her day, it isn't about her latest case in the OR or the interesting patient she saw in the emergency room - it's about her doctors, and her tests, and her treatment plans. The experience is the very definition of surreal.

It seems wrong to me, somehow, that doctors get sick. We're the ones who are supposed to be in control, to make things better for the people we care for. Seeing a doctor in a hospital gown - seeing my friend in a hospital gown - is a reminder of how we're just as human and as vulnerable as anyone else. And I hate it.

I hate too leaving at the end of the evening. I hate that there is no way for me to make her better, to free her from her role as a patient and return her to her preferred role as a healer. Now that she's slipped through the looking-glass, I have no idea how to bring her back.

Simplest Casserole Ever - Tamale Pie Recipe

2011-11-14T21:47:00.002-06:00

What is tamale pie, you ask?

It's a casserole that's very loosely based on a tamale, a Latin American dish consisting of meats/cheeses/vegetables stuffed into a corn-based dough called masa and steamed in a wrapper of corn husks or plantain leaves. The mother-in-law of one of my good friends makes tamales, and apparently they require hours of chopping, mixing, assembling, wrapping, and steaming to make. Tamale pie is exactly the opposite in terms of effort - it is the most ridiculously easy thing I make.

I discovered a recipe for tamale pie years ago when I was still living in Calgary and dating BF#2. The initial recipe had multiple components (chopped onions, spices, corn, homemade polenta), but over time I've pared it down to a four-ingredient recipe that can be assembled in less than 10 minutes. Here it is:

1) Preheat oven to 350 F.
2) In a 9 x 13 inch glass casserole dish, mix together 2 cans of Heinz Chili-flavoured beans (14 ounces each) and 1 can of Aylmer's Chili-flavoured diced tomatoes (19 ounces). If these products aren't available where you live, you can use the equivalent amounts of canned pinto beans and canned diced tomatoes and add some chili spices to taste (chili powder, cumin, garlic, etc.).
3) Top with one roll of pre-made polenta cut into ~1/2 inch slices. Use any extra polenta to fill in the gaps between the slices.
4) Top with generous amounts of grated cheddar, monterey jack, or marble cheese (or some combination of these).
5) Bake for 45-60 minutes until the casserole is piping hot and the cheese is slightly crispy.
6) Enjoy.

I love this recipe because it's so easy to make and it freezes beautifully. And unlike many things that I've made and frozen in the past, I will actually take it out of the freezer and eat it. (I'm very fussy about things that have been frozen, so a lot of dishes that I've lovingly made and put in the freezer have ended up in the garbage rather than on my dinner plate because they didn't taste good reheated.)

Here's what it looks like:

Mmmm. Even my Mom liked it. And that's saying a lot, as she's waaay fussier than I am.

And the best part? It goes really well with homemade fudge.

Sunday Night Miscellany

2011-11-13T22:26:00.001-06:00

Home Call:

I made the mistake of going in to round late today, thinking that it would be short (ha) and that there wouldn't be any urgent consults (ha ha). Unfortunately my day devolved into a series of unstable patients and "You must come see this person NOW!" consults that kept me at the hospital until way past my planned departure time of 2 PM. Luckily, my Mom arrived late for dinner, so I actually had about 10 minutes at home to eat fudge and check Facebook before her arrival. I'm trying not to think about the fact that I'm still on call for 36 more hours and therefore could get called back to the hospital at any time.

Maternal Visit:

The moment my Mom walked into the door, she recognized how wiped I was, and so she kept the nagging to a minimum. (She did point out that there were dirty dishes that I hadn't loaded into the dishwasher yet, to which I responded by asking her whether she would've liked me to load the dishwasher before driving halfway across the city to visit my sick friend in the hospital or after coming home from a consult at midnight last night. Touche.) To my Mom's credit, she bought me blackout fabric today and hung it on my bedroom windows, so I should now have a pitch black bedroom at all times of the day. I'm starting another round of nights this week, and I'm so glad to have a better environment in which to sleep during the day. Not sure why it took me 2 1/2 years of call to finally get this done.

Music:

I'm slowly checking out all of the suggestions that were left on my recent post about study music, and I'm finding that I like a lot of the recommended artists/albums. So far I'm planning to order albums by Adele (who I've liked for a while but not known who she was) and Melody Gardot (who I'd never heard of before), and I'm sure that there will be more. Music has such a huge influence on my mood, so I'm really looking forward to having some new albums to enjoy.

Also on the subject of music, I recently went to the Sarah Slean concert and loved, loved, loved it. We bought our tickets at the last minute, and I almost backed out because I was tired - but then it occurred to me that I would never do anything if I waited to not be tired. So I went, and I'm so glad I did. She's an energetic, dynamic, quirky performer, and it was a great evening despite having to run home to sleep the moment it was over. Her latest album Land and Sea is now on constant rotation in my car/on my computer. I am particularly in love with her song Set it Free, which is about letting go of the things that are weighing on you and bringing you down. With the current state of affairs in my world, how could I not love these lyrics?

Running your poor self ragged

Trying to outrace these stubborn boots

Baby put down that baggage

Oh, that story's old news

What do I do with my sorrow?

Well, if you're asking me

Set it free

Throw it into the sea

Oh, let go of the leash

You gotta set it free.

Yep. Am loving this right now. Check out the video below:

Meal Plan - Week Three:

In some ways making a meal plan is getting easier with practice, and I'm glad that I'm doing this, as otherwise I would've made a number of stops for dinners of sugar water and deep-fried potato goodness over the past few days. Tasty, but not something I should be subsisting on. For those of you who are interested, here's the menu for the week:

Saturday - Tamale Pie. I'll post pictures and a recipe of this soon, as it's my all-time favourite fast meal. And it freezes beautifully. I'm just too lazy to move from the couch to get my camera's memory card right now.
Sunday - Chicken with sweet and sour fennel and creamy polenta. I finally had a chance to make this for my Mom, and she enjoyed the chicken but abhorred the polenta. I believe she used the words "cow pies" and "baby food" to describe the latter more than once. Oh well, more for me.
Monday - Leftovers. There are many.
Tuesday - Pork chops with balsamic vinegar. This was a suggestion on one of my earlier posts (can't find the link in my current state of laziness), and it looks like a nice easy meal. It's entirely possible though that I'll save this for the weekend, as my fridge is a bit overrun by leftovers.
Wednesday - Leftovers.
Thursday (first day of nights!) - Penne with meat sauce.
Friday - Leftovers.

I was a bit unsure of what to make for my two weeks of nights, but I ultimately decided to make a few casseroles that will freeze well and be easy to heat up at the hospital. Between my recent Mexican pepper casserole, the tamale pie, and the penne with meat sauce, I should be set.

Closing, and an Update that isn't an Update:

I hope that all is well with everyone. There is still time for Sister Wives (love the trashy Sunday night tv) and perhaps another piece of fudge before I go to bed, so I'm off soon. There's no news on A today, but I'm going to assume that's a good thing. I've had my cell phone turned on and with me all day, so if anything had changed, I'm sure the great friend network would've let me know. For everyone who has been thinking of her and/or sending prayers, thank you. I may not be a believer, but it is comforting to know that others are thinking of her and wishing good things for her. It certainly can't hurt.

Exhaustion

2011-11-12T21:58:00.002-06:00

I've been composing blog posts in my head all day - while driving to the hospital to round, to the grocery store to buy food for A, to home to cook, to another hospital to visit A - and I had some good thoughts that I was going to try to get out. But the moment I sat on my couch, the wave of exhaustion hit, and there's nothing left in me for a serious post. So this is just a quick check in before finding something to watch on my PVR and resuming petting the cat who is purring eagerly on the couch beside me.

Things are unfortunately not good with A. Not imminently bad, but it will definitely be a long time before anyone is able to (hopefully) breath a sigh of relief. I spent less time with her tonight than I would've liked, as apparently visiting hours do apply to me when I'm not in my capacity as a resident. Who knew I could get kicked out of a hospital? It was good to see her, as well as a friend who also stopped by, but there was so much worry amongst us all. We all know too much.

It's funny...I feel like I've aged tremendously over the past five years, between going through medical school and losing my Dad. I thought that my maturing, at least in any major sense, was over. But driving home tonight, looking out my car window at all the twenty-somethings shivering outside the bars in their short skirts, I suddenly felt unbelievably old.

(Dear pager - Are you kidding me? How do you manage to be quiet all day and then go off with a consult at 10 PM when I'm about to call it a night? I hate you.)

Shock

2011-11-12T09:11:00.002-06:00

Last night, while on my way to a "Girls' Night In" appetizer and dessert party, I got one of those phone calls that you never want to get. One of my friends, let's call her A, had just been admitted to hospital. It wasn't a complete surprise, as she's been sick for a while, but this was a move in the wrong direction, a ramping up in the intensity of her illness. In one moment, things changed from "most likely will recover" to "uncertain prognosis".

I hate being on this side of illness. I hate being the one emotionally involved, not able to just turn off the pager and go back to my safe home at night. I hate too the randomness of this, the great cosmic lottery that sometimes gifts people with shit when they least expect it. It's moments like these where I'm thankful to be an atheist - if I believed that things like this were the intentional actions of an omnipotent being, I think it might destroy me.

And the worst part of it all is it's not about me. Everything I'm feeling right now, all of my anger and sadness and fear, is but an echo of what my friend must be feeling while she lies alone in her hospital bed.

Why I'm A Bad Person (On Reflection, For Multiple Reasons)

2011-11-11T11:19:00.004-06:00

While on my most recent string of night shifts, I was feeling a bit sorry for myself and decided that I needed something special to make myself feel better. My fall outerwear was in a sorry state - I was still wearing a faded, too-small corduroy jacket that I had bought 5 years and about 20 pounds earlier - so a new jacket to wear on the chilly walk to and from the hospital seemed like the perfect item. I checked out my usual stores, but I couldn't find anything that was the mix of stylish, cozy, and self-indulgent that I was looking for. And then one of my friends bought a gorgeous Lululemon fleece, and it was exactly what I wanted.

I've been irrationally and vehemently opposed to Lululemon for years. I've always been shocked by their stupidly high prices, and I've hated how many people wear their clothes like a status symbol. From the first time I set foot in their store, I vowed that I would never waste my money there. But then I found the fleece that I wanted, and all of my previous indignation and moral superiority was thrown out the window. (Bad Person Example #1)

Isn't it pretty?

I love this fleece. (And no, this isn't a product endorsement. But given that I've already sold my soul for a fleece jacket, I'm sure I'd have no qualms about writing a glowing review on my blog in exchange for merchandise.) It fits well, it's stylish enough for something to wear to work, and it's wonderfully cozy against the harsh Canadian fall. It actually did make me feel less grumpy when I would head off to work in the evenings, and I loved cuddling up in it while trying not to drift off to sleep at morning report. Let's just say I've become rather attached to it.

So here's where I display how bad a person I really am. When shopping for groceries last weekend, I was greeted by an elderly Canadian veteran selling poppies. Which of the following do you think was my (thankfully internal) response?

A - How wonderful that this gentleman still has the health and energy to be out selling poppies despite his advanced age.
B - I already have a poppy for my other jacket, but I should buy another one given how worthy a cause this is.
C - Wow - this man actually fought overseas in defense of my country and the values I believe in.
D - I can't buy a poppy - it might tear my Lululemon fleece.

If you guessed D, you have some sense of the monster I've become. How horrible a person am I that this though actually crossed my mind, however briefly?

In all seriousness though, my immediate reaction is a good illustration of just how sheltered and blessed a life I live. I'm so fortunate that my worries are about the integrity of my latest purchase, rather than about the safety of myself or the people I love. So today, I'm taking a moment to think about the veterans whose sacrifices have made it possible for large parts of the world to live in peace. I may be becoming progressively more superficial with age, but I still remember.

Learning

2011-11-09T22:09:00.000-06:00

As an undergraduate student, knowing what to study was easy. Each course had a defined curriculum, and there were frequent assignments and exams to evaluate your progress - all you had to do was put in the hours needed to get the work done. In medical school, the volume of work increased considerably, but there was still a clear, finite body of information that you had to learn.

Enter residency.

Suddenly there are no classes, no curriculum, no clearly outlined list of things that you need to know. When you ask for advice from attendings and more senior residents, they give you vague platitudes like "Make sure you read something every night" or "Study the things you'll need to be a good doctor". Not helpful.

I struggle all the time with not knowing whether I'm studying the "right" thing. My approach has been to try to read all of Harrison's by the end of residency, but I don't know whether I'm pushing myself too hard by tackling such an information-dense textbook or whether I'm slacking off by not reading multiple sources. When I study, I never know how much of the information to focus on. Is it enough to know the primary regimens for treating active TB, or do I also need to know the regimens for the different types of drug-resistant TB? Is it enough to know that carcinoid tumours can cause ectopic ACTH secretion, or should I be trying to learn the specific subtypes of carcinoid tumours? It makes me slightly insane at times.

And then there's the question of how much time to spend studying, which I suspect will plague me until I either retire or die. (Hopefully I'll achieve the former before the latter.) If I knew what the objectives were, I could measure my performance against them and adjust my study time accordingly. But when there are no defined objectives, how do I know what "enough" studying is? I allowed myself to take tonight off of studying because I'm almost deliriously tired, and now I'm second-guessing myself. Am I being kind to my weary, shouldn't-have-stayed-up-late-last-night-watching-Glee self, or am I screwing myself over by giving up an essential evening of studying?

When I'm around other residents in my program, I find myself constantly comparing my knowledge to theirs in the hope of getting a sense of where I am relative to other people. I suspect this is just another crazy-making activity that I should avoid, however, as I inevitably judge myself by much harsher standards than I do others. I may be able to think of six things that can cause erythema nodosum, but if the resident next to me can think of seven I feel like an idiot.

I don't know that there's a right answer to this dilemma. I suppose the best thing is to just keep chugging forward, working as hard as I can while staying somewhat happy and engaged in life. It's the best method I've figured out so far.

----

And now in food: Tonight was supposed to be dinner with my Mom, but we postponed the evening because her work schedule for the day changed and she was no longer going to be in the city. Given my abundance of leftovers (and of unwashed dishes in my sink), I opted not to cook an entirely new meal just for myself. I did, however, feel like making something (I seem to have become addicted to cooking over the last few weeks), so I decided to make a side dish to go with my leftovers. I've been wanting to try making cornbread for a while, and tonight seemed like as good an evening as any for my first attempt.

As I scoured Epicurious for a good recipe, I was a bit surprised to discover how passionate people are about their cornbread. It seems like there are two cornbread camps - salty and sweet - and that people are almost morally opposed to cornbread that doesn't fall into their preferred camp. (In my city rye bread is the starch we get passionate about. When I was living in Calgary, I used to buy bags of my favourite rye bread to take back with me every time I would come "home" for a visit.) I didn't know which camp I'd fall into, as I've had virtually no exposure to cornbread in my life, so I opted for a sort of in-between looking recipe for green onion and jalapeno cornbread.

Yum yum yum. Light, flavourful, moist. So good. I think I may need to make more of this in the future.

Rewards

2011-11-08T22:16:00.001-06:00

After finally (finally!) slogging through the mammoth Harrison's chapter on tuberculosis, I decided to reward myself.

The first thing that came to mind was reading the Harrison's chapter on paraneoplastic syndromes. You know. For fun.

I think the second thing that came to mind was a better idea (although I must admit that I read half the chapter on paraneoplastic syndromes before hunting down the hot fudge and marachino cherries).

I'm now off to enjoy said dessert while watching Parenthood. Hope everyone is enjoying their evening.

Why Crazy People Shouldn't Write Meal Plans

2011-11-08T17:00:00.005-06:00

Do you know what sounds like fun? Cooking two elaborate dishes when post-call.

Um...yeah...actually, not fun. But that's what I planned for dinner last night when I was making my meal plan on Saturday, and I was determined to stick to the plan. So after getting barely enough sleep post-call to feel human, I dragged my still-in-pjs self into the kitchen and started making Mexican pepper casserole and sweet potato soup. When I started at 5:20, I was actually kind of looking forward to making something a bit complicated and to putting my burgeoning cooking skills to work. After 2 1/2 hours of peeling, chopping, slicing, mixing, grating, and blending, I just wanted to get the hell out of the (expletive deleted) kitchen.

Fortunately, I at least got a very tasty dinner for my efforts. Here's the stove at the end of my travails:

Mexican pepper casserole. I think the ratio of peppers to sauce was a bit high for my liking, but it was still tasty.

Sweet potato soup. This is one of my favourite recipes of all time, and definitely my favourite soup recipe. It's like sweet potato crack. Mmmm.

My dinner.

Even better than having a tasty dinner last night, I have enough left over for 13 more meals (as long as I eat just one of the dishes per meal). Fourteen meals isn't a bad trade-off for 2 1/2 hours of cooking.

Unfortunately, my cats still haven't figured out how to wash dishes.

The Hazards of Driving Post-Call

2011-11-07T09:45:00.000-06:00

Fortunately this isn't the first time I've pulled a hubcap off my car, so I'm adept at putting them back on.

I think it's time to go to sleep.

Why Haven't I Been Making Brownie Sundaes All My Life?

2011-11-06T14:16:00.002-06:00

When I serve dessert, I usually go to one of two extremes - either something ready made that requires no effort at all or something completely from scratch that takes half a day to make and leaves my kitchen in a state of chaos. (Mostly the former, because I like avoiding unnecessary effort.) When I was thinking about what to make for my friends who were coming for dessert last night, my mind again went to the two extremes, debating between froze mini eclairs that are ready when defrosted and trifle with homemade pound cake and custard. And then it came to me - brownie sundaes.

I had a box of brownie mix that had been sitting in my cupboard since I was ward senior and hadn't found the time to bake it for my ward team as planned. It took a grand total of five minutes to grease the pan and mix the batter, and then the main component was done (minus baking). I picked up the rest of the ingredients while doing my weekly grocery shopping, and then it was just a matter of adding ice cream, hot fudge sauce, whipped cream, and maraschino cherries once everyone had arrived. Easy-peasy. Making the tea took more effort.

Despite having just gorged ourselves on a ridiculous amount of Thai food, everyone finished every bite in their bowls. The apartment was filled with the clattering of spoons against china as people scraped up the last dribbles. For the amount of effort required, this was the best dessert ever.

Even better - there's still one brownie left for me to make into a sundae post-call tomorrow.

Meal Planning - Week Two

2011-11-05T15:53:00.002-05:00

Meal planning is a pain in the butt. Trying to think of things to cook, hunting down the recipes, checking to see what supplies I have in my cupboard, making a grocery list....it hurts my brain. But not having to think about what I'm going to eat when I come home from work: priceless. And not having to eat tv dinners containing compressed chicken cubes in MSG sauce: even more priceless. The initial bit of effort that it takes to plan ahead is definitely worth it.

Thanks to everyone who left meal suggestions on my earlier post (and feel free to leave more meal suggestions whenever you want). I've now started a word document with lists of things I've already cooked (good and bad) as well as things I would like to cook, and all of the suggestions have been incorporated. C's suggestion of soup reminded me of one of my favourite soups ever, which I'll be cooking post-call on Monday. (Here's hoping I'm alert enough to get all of the ingredients into the pot and to remember to put the lid on the blender.)

For anyone who's interested, here's the list for this week:

Saturday (today): Thai food with friends. Brownie sundaes at my place for dessert. (Mmmmm.)
Sunday: Leftover buffalo chicken and smashed blue cheese potatoes.
Monday: Sweet potato soup from the Sundays at Moosewood Cookbook and Mexican pepper casserole from the Moosewood Cookbook.
Tuesday: Leftovers
Wednesday: Chicken with Italian sweet-and-sour fennel and creamy polenta. This is my first re-run, and I'm looking forward to making it for my mom. There will be wine in more than just the sauce for the chicken.
Thursday: Leftovers.
Friday: Appetizer and dessert party at a friend's house.

The meal plan this week is definitely made easier by the fact that 1) cooking for one person always generates lots of leftovers and 2) I'm eating out on two nights. But I'm still impressed with myself for finally getting my act together with the cooking. It only took 14 years of living on my own.

Edited to add: I think my local grocery store uses my meal plan as a guide for what not to buy. Last week they were out of shitake mushrooms (an ingredient in the Turkey Chow Fun I made) but had a beautiful display of fennel. This week they've restocked the shitake mushrooms, but are out of the fennel I need for Wednesday's dish. Grrr. Apparently there's a downside to meal planning.

Kidlets

2011-11-05T00:54:00.000-05:00

After work today, I babysat my two nieces, L (age 5) and J (age 7), while my brother and sister-in-law went to a work function. When the girls were younger, this was something that I dreaded doing. The girls spent the first few years of their lives living in a different city from me, and it took them being "home" for a year or two to really feel comfortable being left alone with me. Babysitting in the early years was therefore filled with tears and increasingly desperate pleas for "Mom. Mom? Mom!" instead of Auntie SD. I also felt strangely panicked taking care of the girls, convinced that somehow through my misjudgment and ineptitude I was going to bring harm to the two precious lives with which I had been trusted. In my mind, the staircase in my brother's house wasn't a passage from one floor to another - it was a slippery spiral of death down which an unsupervised child would surely tumble. The bathtub wasn't a means of getting clean - it was a death trap of potential scalding and drowning if I turned my back for even a moment. By the end of a night spent babysitting, I would greet my brother and sister-in-law with relief that I wouldn't have to comfort any more crying children and that I had managed to keep said children alive in their parents' absence.

Fortunately, with age and experience the girls have taken a bit of a liking to me, and my paranoia about being the one in charge has dissipated somewhat. (Although I still check the front door multiple times to make sure it's locked against the child abductors.) I've even, over time, come to look forward to babysitting. The girls view it as a treat to get to spend alone time with me (I bribe them with candy), and I enjoy being able to escape into the world of kids for a little while. And the girls think I'm cool, which is an exceedingly rare thing for an internist who reads books on neurobiology for fun.

I will admit that, a lot of the time when I babysit, I rely too much on tv and the computer to entertain the kids. They certainly don't mind - being allowed unlimited time to play Moshi Monsters is on their list of the best things in life - but it's not a great way of spending quality time with them. So tonight I dragged them away from making electronic cupcakes to feed their Furi and their Moppet and forced them to interact with me. We played a game of Sorry, which was frighteningly reminiscent of when I played the game as a child. I could see my own competitiveness in J when she gleefully sent L's game pieces back to the start, and J's sulking when L did the same thing back to her was just like me as a kid. After the game I taught the nieces how to fold origami cranes (my one trick up my sleeve) and was reminded that it's slightly too complex an activity for kids who are still developing their fine motor skills. To end the night, we crawled onto J's double bed together and the girls read to me. Usually the book of choice is a princess fairytale or something by Mo Willems, but tonight they decided to share their recently published yearbook with me. I must be a very good auntie to have listened to them read out every kid's name from pre-K to grade three without screaming.

Lying sandwiched between the two warm children, fending off unintentional blows from their flailing arms and legs, I was struck by how differently my life could have turned out. If I'd met the right person at the right time, I could've been in a cozy bedroom in my own house listening to my own kids sleepily reciting the names of their schoolmates. I could've been looking ahead to a weekend of swimming lessons and children's yoga, instead of planning to go to my own yoga class and to go to dinner with friends (no babysitter required). I can't say that I was sad, exactly, but I was certainly pensive. I don't know that my life would've been better if I'd married and had a family, but it certainly would've been fuller, bigger. My life as one person often feels plain, and small. Not necessarily bad, but just not as much as it could've been.

The Two Solitudes

2011-11-03T21:19:00.001-05:00

When I was going through medical school, I was amazed at how distinct a division there was between the students who loved surgery and those who hated it. The former group spoke with evangelical zeal about their OR experiences and could get excited about being allowed to put a single stitch into a patient. The latter group, in which I was included, abhorred the hours spent in the OR trying desperately not to evoke the wrath of the surgeon or (worse yet) the scrub nurse.

(In typical future internist fashion, I seemed to have a knack for doing things that angered the scrub nurses. I can distinctly recall being glared and/or screamed at for not being able to get my fingers into the surgical gloves fast enough or for unconsciously reaching up to scratch my itchy nose after being scrubbed in. Good times.)

In internal medicine, there's a similar division between the people who are interested in procedural specialties (gastroenterology, respirology, cardiology) and those who aren't. (Guess which category I fall into.) My lack of interest in procedures isn't serving me well on my current respirology rotation, as three to four half-days per week are spent in the bronchoscopy suite. The first half day was alright - it's kind of interesting to look inside a lung, and it's nice to have a visual image of the diseases I'm diagnosing and treating. After the first half day, however, I discovered that bronchoscopy is pretty much the same thing over and over again, with a small bit of variety introduced by the presence or absence of structural changes, infection, and tumours. Not my cup of tea.

Today the universe gifted me with an entire day of bronchoscopy. By 10 am, I was contemplating faking a vasovagal attack so that I could remove my sweaty gown and sit down in a well-ventilated area. By noon, even my constant shuffling from foot to foot couldn't relieve the unrelenting ache in my lower back. By 3 PM, I was discovering religious faith for the first time in my life, mainly because I began to believe that I had died and been sent to hell by a wrathful god. Fortunately I was too exhausted to let out a cheer for joy when the scrub nurse announced that we had completed our last scope of the day, but there was certainly a cheer going on in my weary brain.

Despite feeling like I was trapped in the slowest day in the history of time, I did my best to appear interested and to ask questions about what I was seeing. I appreciate the time and effort that attendings take to teach us, and I don't want to be disrespectful of that by looking bored and not paying attention. Apparently I'm not that great at faking enthusiasm, however, as when we left the bronchoscopy suite the attending looked at me with a twinkle in her eye and said "So, I guess you're not dying to become a respirologist, are you?".

Oh...how glad I am that there are non-procedural subspecialties in medicine. Oncology here I come.

---

In food news, I made the buffalo chicken thighs and blue cheese smashed potatoes that I spoke about in an early post. (Check out that post for links to the recipes, as I am about to collapse dead from exhaustion and am too lazy to re-link to them.)

I have to say that I wasn't totally thrilled with the meal. It made a lot of dishes between frying, baking, and coating the chicken, and it was just alright for the effort. The smashed potatoes were okay, but again, nothing fabulous. Admittedly I didn't have buttermilk (used regular milk) and I used mild blue cheese (I hate things that taste like moldy feet), so it wasn't exactly as intended, but I'm not sure that it would've been that much better if I'd followed the recipe without modification. (It may just have tasted more like moldy feet. Mmmm.) I may or may not make this again, depending on how it tastes reheated tomorrow night. I find that I often enjoy foods more the second night, after I haven't turned my kitchen into a disaster zone of dirty dishes and vegetable peels, so I might have a revised opinion at that time.

Any suggestions on what I should put into next week's meal plan?

Addiction

2011-11-02T21:40:00.001-05:00

I have a (shameful) confession to make: I'm a computer game addict. It doesn't really matter what the game is - if I get sucked in, I find it nearly impossible to suck myself out.

Sadly, there are many examples from my life to illustrate my point. As a graduate student, my supervisor had to ban Tetris from the lab computers so that I would do my experiments. While I was dating BF#2, he decided to introduce me to World of Warcraft, naively thinking that we could play it together for fun on weekends; I promptly stopped cooking, cleaning, and sleeping for more than five hours a night so that I could squeeze in every possible moment of game time. (Thankfully he recognized the severity of my lack of self control and threatened to break up with me if I didn't let my subscription expire at the end of the first month.) When my Dad was sick, I started playing Cafe World on Facebook, and I would time my visits with my parents so that I would always be home in time to serve the virtual food and start new dishes on the stoves.

I don't know what it is, but there's something about computer games that grabs hold of the reward centre of my brain and refuses to let go. I know on an intellectual level that it's stupid and wasteful, but there's something internal that compels me to keep playing once I get hooked. Fortunately I've gained some insight into my own behaviour over the years, and I've learned to not even get started on a game. I don't play Facebook games (any more), I don't download games to my iPhone (any more), and I certainly don't start playing any addictive online games.

(You know where this is going, don't you?)

Over the weekend, after I had finished studying on Saturday night, I rewarded myself with some takeout sushi and relaxing in front of the tv/computer. While catching up on some of my favourite blogs, a link to online Pac-Man caught my eye, and I followed it without even thinking about what I was doing. Big Mistake. Through a series of links, I eventually came to a website with a free online game that allows users to create their own empires and conquer the empires of others. And within a few short minutes, I was hooked.

Since then, I've been neglecting things - studying, cleaning, responding to comments on my blog. It's amazing that I actually managed to grocery shop and cook yesterday, although I must admit that I was plotting my next move while doing so. Absolutely pathetic. After work today, I rushed into my apartment so that I could check on the status of my building construction and my dungeon raids, and it suddenly hit me that I'd done it again. Once again, I'd let myself get sucked into a time-eating, purposeless computer game.

No more. I've stopped playing, the link is deleted, and I hereby give my blog followers permission to write me angry comments if I show signs of falling off the face of the Earth from being sucked back in. Time for me to behave like a grownup.

(Right now the voice in the back of my head is saying "But all your hard work is going to waste! You almost finished building the stable that will allow you to recruit cavalry to your empire! Just play a little bit longer!)

Yep. Ignoring the voice.

---

On another note, I did manage to drag myself away from the computer screen long enough to visit my nieces on Halloween. How could I miss a five-year-old and a seven-year-old doped up on adrenaline and refined sugar? Here's a few (non-identifying) photos.

Jack-o-lanterns:

A Halloween cat:

The spoils:

Lining the spoils up so that they can be eaten in the correct order. (I think the youngest niece takes after me.):

Hope everyone had a great Halloween and is managing to be more productive than I have lately.

Goals

2011-11-01T22:12:00.000-05:00

I've had a bit of a blogger crush on Sarah at the SHU box since I started reading her blog a few months ago. For anyone not familiar with her, Sarah is a pediatric endocrinology fellow who somehow manages to find the energy and motivation to exercise regularly, cook healthy meals for herself and her husband, and blog almost daily. And this is despite now being 18 weeks pregnant. Prior to discovering her blog, I had a lot of great excuses for all the things I don't do regularly - I'm busy, work is busy, no one manages to do anything more than survive while in residency. And yet, there was Sarah's blog, reminding me on a daily basis that someone in similar circumstances is managing to do all of the things that I'm not.

(Assuming that Sarah is not actually a cyborg. Which is still a distinct possibility.)

Sarah's blog has made me realize that I can do more than I'm doing right now. Not that I will ever be a perfect person with an immaculate home and a size 2 body and a fridge filled with organic produce and free-range meat - but I don't have to be a lazy person living in abject squalor who dines at the Golden Arches every day. A happy medium is possible. As anyone who's been reading here for a while may have noticed, I have been making attempts to strike that happy medium - I've been cooking more, I've been making study schedules for myself, and I even dragged myself outside for a few runs last month. And all of this has been good, but I want to keep working on things and getting better.

So, I'm going to borrow an idea of Sarah's, which is to work on smaller, achievable goals. I have a bad habit of setting big lofty goals for myself and then failing miserably at them. ("This month I will study three hours a day, work out five days a week, and cook every night because I am now amazing!"*) I know that if I want to keep changing things for the better, I need to focus on gradual change in the right direction rather than attempting to completely overhaul my life all at once.

So, I'm setting a goal for this month of meal planning and grocery shopping. I'm reasonably good at cooking meals when I have something decided on and I have the components in my fridge, but when the fridge is bare I'm very likely to stop for fast food on the way home from work. I even justify it to myself by saying that it's much faster than shopping/cooking, so it will allow me to start studying sooner. (Not good logic.) Hopefully by doing more planning and grocery shopping I'll be able to avoid the trap of the fast food.

If you're interested, here's my meal plan for the week:

Tuesday: Turkey Chow Fun
Wednesday: Leftovers
Thursday: Buffalo Chicken Thighs with Blue Cheese Smashed Potatoes
Friday: Dinner with nieces

And here's a picture of the Turkey Chow Fun:

This was an absolutely fabulous dinner. It took less than 30 minutes to cook, and I'm sure it could take even less if made by someone who isn't as painfully slow at cooking as I am. It only used one pan, thanks to pre-cooked rice noodles, so it was easy cleanup. And most importantly, it tasted good. Go back for seconds and eat directly from the pan good. (Not that I would ever do that.)

Baby steps.

*If you want to see a hilarious illustration of what setting big goals and then (inevitably) failing can look like, check out this post at one of my other favourite blogs, Hyperbole and a Half.

Go Rick Mercer

2011-10-30T10:36:00.002-05:00

This rant speaks for itself. Another reason why I'm proud to be Canadian. (Rick Mercer, that is. The fact that gay kids (or any kids) are still getting teased and bullied to the point of committing suicide makes me ashamed of some of the people in my country.)

Study Tunes

2011-10-29T10:27:00.001-05:00

When I was a second-year undergrad, studying Organic Chemistry and Biochem until I dreamed in carbon-based molecular structures, I listened to the same two CDs over and over again. The first was Tori Amos's Under the Pink, my first introduction to non-mainstream music and to the whole concept of feminism. (What can I say? I was a sheltered science geek who read Scientific American for amusement. I had no concept of how the world worked all those years ago). The second was Dave Matthews Band's Crash, which was filled with energizing beats to drive me forward when I couldn't bear the thought of reviewing another biochemical pathway.

I listened to nothing but those two CDs through all of my study sessions for that entire year. When I hear a song from one of them, even though it's 14 years later, I'm transported back to the dingy basement hallway in which I studied daily with my friends. We called our study area the wind tunnel, because the pressure in the hallway was lower than in the areas surrounding it, so there would be a gust of wind and a rustling of study papers any time someone opened the door into it. Our university's maintenance budget had been frozen along with our tuition, so the walls were filled with cracks and water would drip from the ceiling when the snow melted in the spring. It was a horrible place, but for that year it was more home to me than my parents' house, which I only visited for a few hours of sleep in between the long days of studying.

Having the right study music, for me anyway, is key to getting the most out of my studying. The music has to be familiar enough to me that I don't get distracted listening to the lyrics, without being boring from having listened to it too many times. (Although, my story above clearly illustrates that I can listen to an album many, many times without becoming bored with it.) The tempo and intensity of the music need to be right for my mood - slow and calming for times when the studying is relaxing and effortless, but uptempo and energizing for times when I'm fading and need an external push. I think that's why the two CDs worked so well for me in second year undergrad. Tori Amos was my daytime music, carrying me through the easier times when I was still alert, while Dave Matthews Band was my evening music, keeping me from falling asleep and drooling on my diagram of the glycolysis pathway.

What motivated me to write this self-indulgent, backward-gazing post is the fact that I'm feeling a bit stuck for study music. Currently, I seem to be listening to the same artists over and over again - David Grey, Coldplay, Sarah Harmer, Sam Roberts, Jack Johnson, Matthew Good - and while they're all excellent, I'm longing for an infusion of some fresh blood. I just added Sarah Slean to the rotation, as I'm going to her concert in a few weeks and feel like I should know at least some of her songs, but it's still not enough. So my question for you, as I bundle up against the cold and head out to Starbucks for studying and a latte, is what are you listening to while you're studying?

(And if you're one of those smart people who structured your life in such a way that you don't have to study anymore, good for you. Enjoy lounging on your couch eating bon bons while I tackle the WHO's guidelines for the treatment of tuberculosis.)

Progress - A Quick Friday Night Note

2011-10-28T22:39:00.000-05:00

Friday is finally here! This week has felt really long, what with spending my days running from the ward to consults to clinic to teaching to evening commitments. I'm also still feeling the effects of my recent night shifts (I'm really slow to adjust this time), so I've been dragging a bit from an energy perspective. But the weekend is here, and all I need to do is jump the hurdle of one last home call tonight and then my time will be my own again for 48 hours. It shouldn't be too bad, as the ward is full and most of the patients are fairly stable.

(Dear Universe, please don't view my previous statement as an invitation to make the Respirology ward explode with sick patients or to make eight people with spontaneous pneumothoraces present to the Emergency Room simultaneously.)

So far tonight my only pages have been from Pharmacy asking for help reading orders that I wrote earlier in the day. Apparently things written with my favourite Bic fine-point blue pens don't always transmit well over the fax machine. :( So I am now the proud owner of three boxes of Bic fine-point black pens, which I will use for all future medication orders. Things are getting wild and crazy over here in Solitary Diner's world.

The hospital was relatively quiet today, so I was able to sneak away from the wards and get in some study time. It feels like I haven't studied in weeks, and it's actually really nice to get back to it. The things I see in the hospital make so much more sense and stick so much better in my brain if I have some theoretical knowledge behind them (and vice versa). One of the things I was reviewing today was the differential of bronchiectasis, and it was satisfying to realize that I've seen almost every item on the differential at some point in my clinical career. As I was reading, I kept thinking "Oh yeah, Mr. H. on the Respirology ward has allergic bronchopulmonary Aspergillosis" or "Mrs. C. from the Medicine ward last year had hypogammaglobulinemia". It's definitely much easier to remember things when I can put a face to them.

Thanks to the time in the day today and a relatively quiet evening, I'm on track to complete my study goals for the week. Currently, my goals look like this:

Week One – October 24-30:

- ~~Journal Club articles and review questions~~

- Harrison’s:

o ~~Chapter 251 Approach to the Patient with Disease of the Respiratory System~~

o Chapter 165 Tuberculosis

o ~~Chapter 329 Sarcoidosis~~

o ~~Chapter 263 Disorders of the Pleura and Mediastinum~~

- Chest 2011 COPD Guidelines

And I have tomorrow set aside for mostly studying. I may study the chapter on bronchiectasis and lung abscesses that was scheduled for next week instead of the COPD guidelines, but otherwise it looks like I'll meet my goals exactly. Go me! I have to say that setting goals for this rotation has been a really positive thing. I've been a bit scattered with my studying so far in residency, and it's left me with the feeling that I'm just learning random facts rather than whole areas of medicine. It's nice to know that, if I stick to my current study schedule, I'll have covered all of the major areas in Respirology by the end of the rotation.

So that's the current state of things in my endlessly exciting life. I'm about to watch some PVRed Grey's Anatomy while waiting for the ward to page me back about a new admission who needs some orders clarified, and then it's off to bed so that I can get an early(ish) start on the day tomorrow. Less than two chapters of Harrison's to get through tomorrow. Easy-peasy. If I finish early enough, I may even take the time to write some of the posts that have been brewing in my head ever since our Women in Medicine evening last night. I promise they'll be more interesting than my discussions about the type of pens I use.

Not Helping

2011-10-26T22:15:00.000-05:00

(Before reading this post, please understand that I love my Mom dearly. She just drives me utterly crazy at times. Hence the post.)

My mother phoned tonight. Phone calls from her always put me slightly on edge, because without warning she can hit me with the full force of her mom guilt (see here for example) or mom judgment. Tonight was no different. After a relatively benign conversation about what was going on in our respective lives, she asked me what I'm doing this weekend. When I said that I would have time to get together with her (yay for a full weekend off!), she commenced with the following:

Mom: "Oh good! I think we should use the time together to organize your storage space."

SD (under my breath): "Wheeeee."

Mom: "I can't believe you've been living there for an entire year and you haven't organized your storage space yet. It's a disaster!"

SD: "That's why it has a door. Which I close."

Mom: "You can't just close the door, Solitary. A storage space should be organized! You should've done this by now."

SD: "I've been kind of busy."

Mom: "Busy? What have you been doing that's so important?"

Um, really? REALLY? What have I been doing that's more important than cleaning my storage space? How about my internal medicine residency? Hmmm? Important enough for you?

It makes me want to scream! (Or vent on my blog.) My Mom legitimately does not understand why I don't find the time to do things like organize my storage space (and hang pictures, and go to the gym, and clip coupons, and any number of other really important things that I'm apparently supposed to be doing.) And it is the single most difficult thing about my relationship with my Mom.

In case anyone is wondering, here's what my one evening at home for the entire week looked like:

4:30-5:00 Drive from work to grocery store
5:00-5:45 Buy groceries
5:45-6:15 Drive home and unpack groceries
6:15-7:15 Cook and eat supper
7:15-9:00 Study
9:00-9:20 Talk on phone to Mom while unloading/loading dishwasher, tidying apartment, and assembling recycling
9:20-9:45 Finish tidying apartment, take out recycling, unload cat litter from car
9:45-? Blog and personal time

And this is not an atypical evening for me. If I had been able to find more time in the evening, it would've gone to studying - not to organizing my storage space.

I hate that most people outside of medicine (or outside of another demanding job/life circumstance) just don't get it. Before I started medical school, I really didn't get it either. I didn't understand why my friends in medicine rarely had the time to get together or why they always seemed so tired when they did make time to see me. I get it now. Medicine is a take over your life, eat up your time career, particularly when you're in training and trying desperately to cram all 4012 pages of Harrison's Principles of Internal Medicine into your brain. Unless you're a much more efficient person than I am, it doesn't leave you with time to organize your storage space.

Ahhh. I feel much better having blurted all of that out onto the internet. (Thankfully my Mom is completely computer illiterate and so could never find this blog even if she knew it existed.)

Anyone have any great suggestions on how to help people outside of medicine understand what it's like from the inside?

Best Laid Schemes of Mice and Men

2011-10-25T20:30:00.004-05:00

Until it actually started, I was looking forward to my current Respirology rotation. The service is reputed to be only moderately busy, and we have two residents, so I envisioned leisurely work days with lots of time to mull over my consults and do background reading on my patients. With work days ending by 5 PM, I anticipated evenings with abundant time for both studying and normal life activities. So optimistic was I about how laid back this rotation would be that I put together the following rather ambitious study schedule for myself:

Week One – October 23-29:

- ~~Journal Club articles and review questions~~

- Harrison's:

o ~~Chapter 251 Approach to the Patient with Disease of the Respiratory System~~

o Chapter 165 Tuberculosis

o Chapter 329 Sarcoidosis

o Chapter 263 Disorders of the Pleura and Mediastinum

- 2010 Chest Medicine COPD Guidelines

Week Two – October 30-November 6:

- Harrison’s:

o Chapter 33 Dyspnea

o Chapter 34 Cough and Hemoptysis

o Chapter 35 Hypoxia and Cyanosis

o Chapter 89 Neoplasms of the Lung

o Chapter 258 Bronchiectasis and Lung Abscess

o Chapter 261 Interstitial Lung Diseases

Week Three – November 7-13:

- Harrison’s:

o Chapter 260 Chronic Obstructive Pulmonary Disease

o Chapter 264 Disorders of Ventilation

o Chapter 265 Sleep Apnea

Week Four – November 14-16:

- review previously studied material

- if time:

o Harrison’s:

- Chapter 252 Disturbances of Respiratory Function

- Chapter 253 Diagnostic Procedures in Respiratory Disease

- Chapter e34 Atlas of Chest Imaging

I really had great plans for the next three and a half weeks. Unfortunately, as it always does, reality had something different in mind. Yesterday, I had only three hours on the ward in which to review and meet my new patients before heading to Sleep Disorders Clinic. Then today, I again had only three hours between Grand Rounds in the morning and Academic Half Day in the afternoon to see my patients, review a new admission, and see a new consult in the Emergency Room. (To add to the challenge of the morning, I had to see the consult in the back of the resuscitation area due to lack of beds. And the patient was getting a CT scan done until 15 minutes before I was scheduled to review the consult with the attending. Awesome.)

Evenings haven't been much better. Last night was spent frantically trying to decode a 60-page chapter on statistics*, followed by a late-night run into the hospital to admit a new patient who conveniently arrived at 10 PM. Tonight was spent at a Journal Club discussing the 60-page chapter on statistics while trying not to fall asleep or suffer a mental breakdown from frustration. Thursday night is a Women in Medicine evening, and Friday is another night of home call. So tomorrow night - ahhhh, tomorrow night - is my one night this week with no call or other commitment. Think I can study three chapters of Harrison's and the 2010 COPD Management Guidelines in one night**?

* I wish I could have downloaded Old MD Girl's statistical knowledge into my brain. It would've made Cox hazard ratios and propensity scores much easier to understand.

** My apologies for this ridiculously boring post. It seemed like something people would be interested in when I started writing it, and now that I've completed it and realized that it really isn't all that interesting I don't feel like wasting the effort by just deleting it. Here's hoping I will come up with something more interesting to say before people begin a mass exodus away from my blog***.

*** Inasmuch as 37 followers leaving a blog constitutes a "mass exodus".

Excessive Daytime Sleepiness

2011-10-24T18:42:00.001-05:00

I started my Respirology rotation today, and as part of the rotation I spent the afternoon in the Sleep Disorders Clinic. In between patients, the attending took a lot of time to review the pertinent facts of the cases and to teach around them. Much of the teaching revolved around sleep apnea, as this was the most common condition for which patients were being evaluated. One of the things he kept emphasizing was that excessive daytime sleepiness, as indicated by falling asleep when the level of stimulation is low (watching tv, reading, driving, etc.), is a characteristic symptom of sleep apnea.

(I will remind you all now that today is only my fourth day since I switched from nights to days, and it usually takes me at least a week to fully transition between the two.)

Mid-afternoon, the attending handed me a patient information sheet to review in his office while he went to run a quick errand. Between the slightly warm room, the high-back chair, and the low-stimulation information sheet, I didn't stand a chance. On his return, the attending found me leaning back in the chair, mouth agape, with drool coming out the side of his mouth.

"Oh, I'm sorry," the attending remarked. "I thought you were a resident who came for a teaching session, not a patient who came for sleep apnea testing. Perhaps I should hook you up to the polysomnography equipment?"

At which point I demonstrated the ability to blush like only someone of Northern European ancestry can.