The world of medicine is like a bubble. A lot of people THINK they know what goes on there, but unless you're down in the trenches it's unlikely you do. So here is my semi-anonymous blog, here to tell you what really goes on in the life of a medical resident.

Wednesday, October 10, 2007

Eleventh Hour Panic

So as much as I’ve tried to deny what comes next, my pregnancy is quickly nearing an end. I am well into the third trimester—my hands are constantly puffy, I don’t remember what my feet look like, putting on socks leaves me panting for breath, and I have only 17 more days of work until my maternity leave starts.

I haven’t been a good pregnant woman. I haven’t eaten as well as I should. My well-balanced, healthy diet went out the window in the first trimester with nausea and food aversions, and I haven’t managed to regain control over it. I rarely remember to take my prenatal vitamins. My exercise routine now consists of walking for an hour 2-3 times a week. I haven’t been swimming, which I intended to do. The prenatal yoga that I managed a few times on out-of-town rotations is a distant memory. Mr. Couz and I haven’t attended any prenatal classes, or even toured the labour and delivery floor of the hospital where I’ll be giving birth. I don’t think I’ve managed to do anything to prepare myself for what lies ahead.

Even my prenatal care has been sporadic. My midwife is very nice, and because I’ve been out of town so often I’ve only attended 3 appointments since my care was transferred to her when I was 20 weeks pregnant. I declined my gestational diabetes test, as my weight gain has been appropriate and I have no family history of diabetes (gestational or otherwise) so I figured it was unnecessary. I enquired about the banking of cord blood vs. delayed cord clamping at my last appointment only to learn that I was far too far along for cord blood banking to be an option. So delayed cord clamping it is.

And now I’m starting to second guess everything I’ve done so far.

Initially when I opted for midwifery care I was very confident in my decision. In the town where I left the midwives had a great relationship with the obstetricians—they were well trained and respected, and the hospital where they delivered was very progressive and baby-friendly. This meant immediate skin-to-skin contact after delivery (unless resuscitation was indicated), no episiotomies, birthing tubs available, lovely birthing rooms that looked less like hospitals and more like living rooms, followed all breastfeeding friendly guidelines (so no well-intended nurse would pressure you to supplement baby with formula because your milk hadn’t come in by post-partum day #2—gah!)… Generally a place where I’d be comfortable to deliver.

In my new town, I’m not so certain. I’ve heard a few cautionary tales about making sure the midwife doesn’t wait too long to consult obstetrics in the case of complications, the relationship between the midwives and the obstetricians isn’t quite as friendly, and the birthing practices seem right out of the 1950’s. And I’m getting nervous.

My midwife is aware of our preferences. We’ve gone over every aspect of the delivery and immediate post-partum period and she is aware of my wishes pertaining to every step along the way. She even seemed okay with the fact that I’d prefer a c-section over an operative vaginal delivery (get those forceps away from me!). I think that between her and my husband they’ll be advocating for me if I’m not able to. But still I’m starting to wonder if I’ve done the right thing.

Should I have just gone with an obstetrician? There is one in town who seems to be universally loved by other physicians and patients alike. Of course, I still wouldn’t have been able to guarantee that I’d go into labour while she was on call. As ashamed as I am to admit it I’d still prefer a scheduled c-section over the unpredictability of a vaginal birth, but I am also well aware that no obstetrician in town would agree to that. And since the Bean has been vertex (head down) for weeks already, it looks like my semi-subconscious wishes that he would be breech have gone unheeded. So it looks like I’m doing this the old school way.

What about a family doctor? The one that was recommended so highly by a number of people refuses to accept my family into her practice, even as a professional courtesy. Her practice is closed, and she isn’t accepting new patients regardless of who they are. So much for the perks of being a physician. Having her deliver my baby would have been a back door into her practice, and it would have secured my family a primary care provider.

I don’t know why I’m starting to question all of this now when I’ve been perfectly comfortable with my choice since the beginning. As with all of my other neuroses lately, I’m going to assume it’s hormonal.

Monday, October 08, 2007

I'm Just a Rolling Stone...

One thing that has been particularly difficult about my medical training in general is the fact that it's never been in just one place. In the 10 years it's been since leaving the city where I grew up, I've moved 5 times. And that's just from city to city. If you include the number of times I've moved locally in that count, it goes up to 7. That's a lot of time spent leaving places, packing, unpacking, and getting to know new cities and surroundings. It's exhausting to think about.

But that's not all. Even my time in one place is divided up into different rotations. During medical school I did electives in four provinces and two continents. It was a great experience at the time. I spent my family medicine rotation in a B&B in a small town, constantly feeling like a guest in a stranger's house confined to a large bedroom. I spent a plastic surgery rotation in a city three provinces away from home again confined to a short-term rental bedroom in someone's house. My first emergency medicine rotation was probably the most bizarre in terms of accommodation-- I was renting a bedroom from the friend of the woman who owned the aforementioned B&B, who also ran a hair salon out of her home. I particularly loved the fact that although she was well aware that I was working shift work, she played talk radio at incredibly high volumes while eating breakfast in the morning-- in the kitchen just off my bedroom. My last elective in emergency medicine, shortly after moving in with the guy who later became Mr. Couz, was prematurely aborted. Three provinces in the other direction and again confined to a small bedroom in a stranger's house in a city where I didn't know a soul, I was so miserable I stacked my shifts in such a way that I was able to catch a flight a full 4 days sooner than initially scheduled.

The end result of all of that moving around is that I am currently feeling a sense of unease. I am currently in my (hopefully) last month of 'away' rotation. I understand the need for it-- there are very few pediatric hospitals in my province (or any Canadian province, for that matter-- we just don't have the population density for it) so in order to get a solid base in pediatric emergency medicine I need to work in one that ONLY sees kids. But lately I've been feeling very homeless.

It's a strange feeling. I feel homesick. But I'm not sure what city I feel homesick for. It changes depending on the day, and sometimes it’s for more than one place at a time.

I miss the town where I grew up in spite of the fact that the only people still living there from my past are my mother and my sister. I miss the neighbourhoods, the shopping, great restaurants… and as I get older I particularly appreciate how nice it would be to live in the same area code as my immediate family. I miss them, and would often give anything to be close enough to enjoy a Sunday dinner the family—and in my somewhat rag-tag family that can include anyone from my mom and sister to my stepdad, my uncle, my cousin and anyone else who happens to come by. I know that I’ll never move back there, however, as the health care system in that province is remarkably similar to third world countries and my husband doesn’t speak enough of the language to be employable as a paramedic.

I miss the town where I did my graduate work—many of my friends seemed to have ended up there, and although the traffic sucks most of the week and the housing has gotten pretty pricey I’d still move back there in a heartbeat. I loved the different neighbourhoods, the transit system (probably the best one I’ve experienced in Canada), the history, nearby greenspaces and rivers, the mix of languages used in everyday business, great restaurants… this is the city where I spent the past month doing pediatric emergency medicine, and I loved the fact that I had enough friends and family there to keep me busy and social on my days off. I reconnected with a lot of people and it made me nostalgic for the city itself.

I miss the town where I went to medical school. More than any other city I’ve lived in, I can see myself moving back there some day. Unfortunately, I don’t think it’s likely considering my past with the emergency department there (see Match Day posts for further explanation if necessary). My husband thinks that I’m just nostalgic for medical school, and he might have a point. Much of the allure of the town came from the people and the strong social networks we had there. I couldn’t leave the house without bumping into someone I knew (both a blessing and a curse) and I loved the fact that half of my building was filled with friends and schoolmates. My apartment had a beautiful view of the lake, my best friend was a 5 minute walk away, and if I needed company all I had to do was cross the hall. My gym, my running routes, the park on the corner… it was my neighbourhood, and it was home for four years. I loved it. Now nearly all of the friends and classmates in question have moved on, but I still have a few good friends kicking around.

More recently I even find myself feeling nostalgic for the town I most recently left behind. Longtime readers of this blog will appreciate the irony, as I hated that city the first time I lived there and was dreading moving back for residency. But the two years I spent there were in a great neighbourhood right near some great wooded trails. We adopted Velcro dog there, got married there, I completed residency there, Mr. Couz retrained as a paramedic there, and we generally settled for two years. Although I bemoaned the distance we were from family (both mine and his) and the fact that most of my friends were residents as well and therefore unavailable for most social activities, I still find myself missing it. And beyond the fact that there was some decent shopping in the area, I’m not even sure what I’m missing.

I guess in each case the common thread is the familiarity. Each town was a place where I lived, worked and played for at least two years. By the time we moved from one place, we had established a routine. We knew where to find decent Indian food that delivered, knew where the off-leash dog parks were, knew a couple of good places to hike nearby, knew where to take out-of-town guests for breakfast… everything essential for making a new place home. And now I’m living in another new city—closer to in-laws but 7 hours of driving away from my family. We’ve been here nearly 4 months already but much of that time I’ve been doing various out-of-town rotations and haven’t had the chance to really get to know the town. My program is very small, and as a result I haven’t met many other residents. The ones I have met are out of town as much as I am, and don’t seem all that interested in getting together more than the required one time a week that we converge for academic half day.

But this is home. We actually own a home here, a first for us. Granted, the upstairs is mostly unfurnished, the backyard desperately needs to be fenced in, and the basement is filled with boxes but it’s ours. Mr. Couz and the dogs are here, which for me goes a good way to making me feel happy. And I know, realistically, that the only way it will start to feel like home is when I make an effort to make it so. But in the meantime, it doesn’t mean I can’t feel a little nostalgic for all of the people and places that I seem to be leaving in my wake.

Sunday, October 07, 2007

Good News and Bad News

So I've been mentioned in a list of the Top 100 Health and Wellness Blogs on a nursing education website.

I'm flattered. Really. But I'm not sure how I feel about being referred to this way:
A Canadian nurse who works in an emergency room provides her insights into her job. This blog reads more like a novel, so make yourself comfortable and enjoy the trauma!
I'm used to being mistaken for a nurse (at work, anyway, where every female in scrubs MUST be a nurse, of course... sigh) but the fact that the person compiling this list mistook me for one makes me think that he/she (I'm not hypocritical enough to assume that the author is a woman just because it's a nursing blog) didn't actually read my blog. Or didn't read much of it. So that leaves me wondering just how much of an honour it is to be included...

Saturday, October 06, 2007

I'm Back.

I'm not sure why it's taken me 2 months to post anything of note. Work has been going okay. I've just completed a month of pediatric emergency medicine out of town, and am now nearing the end of my first half of ICU (my 2-month rotation has been split up into 1 month blocks). I am far enough in pregnancy that I am no longer doing call or night shifts, which kind of makes medicine seem like a normal job-- only at this stage it's all I can do to drag myself through straight days anyway. I haven't done much but work and sleep, and I feel like I'm the size of a house. Running for codes is laughable at this point, as the maximum I can handle is two flights of stairs at a time and even that is slow going.

I've had a few posts on the burner... I haven't been in much of a rush to post them as they seem awfully mopey and whiny. I know that much of it is the hormones talking, but I just didn't see the point in sharing my funk with the public.

So be prepared-- the next few posts (which I will post over the next few days or so) aren't clever or funny. Mostly just random musings and whining. I'm hoping that this too, shall pass and I'll be back to my old self soon. Thanks for the patience.