Reuniting With Some Favourites

I had the best weekend.

We spent time with the core group from our small group from when we lived on that lovely island for med school.  The 7 of us were together for basically 3 years and other people came and went.  It is the first time we were ALL together in 2 years.  I have been looking forward to this time, since I found out it would happen in May.

There are people that life is simple with.  There are people that, for introverts like me, barely count as people.  Who you can just exist with and not feel completely drained.  The kind of people you can just pick up where you left off and hardly miss a beat.

These are those people. 

We went to Magic Mountain, a pretty awesome water park.  We played mini golf.  We made up our very own road trip game to drive to one couple’s home complete with mid-trip car switches.  We stayed up until 2 in the morning playing Sing Star and were up and off to the races again at 10.  We explored a market and watched Highland games.  We grocery shopped and went to games stores.  We BBQed and lounged around just talking for hours.  We played a million new board games until almost 2 in the morning again.  We went to church, we went to lunch and had a great discussion.  

I barely took any pictures except at the Highland games.  

I love that we can be real with each other.  Really, truly honest and open about where we are.  That we can talk about tough stuff.  And in the next breath crack jokes about being “tied and pleasured” (long story).

It was a full weekend.

I was sad it was over.  

We are blessed to have many good friends.  Despite that, we have been feeling discouraged because we don’t have as many close friends where we live currently (but we still have a few we are attached at the hip to), but part of that is because it is so rare to have the kind of friendships we have with this crew we spent the weekend with.  God provided us with great people when we needed them in a certain way and I know He is doing the same here, just in different ways.  It has been a slow go feeling like we are a part of things here.  And part of that is because it was so easy when we were there.  And maybe that is because we needed it to be at that time.

Community stretches you and grows you.  Spending time with what was our main community was amazing.  And comforting.  And a true testament to how awesome God is.  Our church here encourages community, and I can sense the community, but it is bigger and broader than what I once knew in some ways and the relationships, like people are different.  But, then again, so are we.  It is a good thing.  

I am thankful for full weekends.  And friends who change and yet stay the same.  And for the comfort that comes from really loving and knowing people.

We get to go away with some other very special friends this weekend.    People we have known and loved much of our lives. I am super excited.  So, really, we are very fortunate.  Two awesome weekends in a row!

I have a musical interlude for this post.  A song that was stuck in my head the whole weekend and, well, is still stuck in my head.  It isn’t quite about amazing friends or community and yet, in some ways, it fits because of the concept of coming together.  

Top Ten Authors From Whom We Own The Most Books

This week’s Top Ten Tuesday with the Broke and Bookish asks the top ten authors from whom we own the most books. Confession… I kind of like this challenge because it is as simple as looking at our book shelves. I have also come to realize that we tend to only have a book or two by most authors. We are still library people or book borrowing people, so there aren’t as many books on our shelves as we read.

  1. John Green. He is an author both Patrick and I love. Funny, clever and easy to read, but with enough layers and depth that the books don’t get boring.
  2. Jodi Picoult. I know, many people feel her books follow a formula, and I totally agree. That being said, I like how they examine issues from various sides.
  3. C.S. Lewis. We have two anthologies. Not a lot of books in appearance, but a ton if you break them up into individually. I really like his writing, although I haven’t read very much that isn’t The Chronicles of Narnia yet.
  4. Khaled Hosseini. His books books are beautifully written and complex. I also love learning about another culture and country just from reading them.
  5. Ted Dekker. The Circle series is fantastic. The way two worlds are made to overlap and the symbolism blew my mind. We need to add more of his stuff to our shelves.
  6. Suzanne Collins. The entire Hunger Games series is it, but it is a good one.
  7. Stephen King. These are mostly Patrick’s but the one I read was amazing and I might just read one of the less scary other ones.
  8. Mitch Albom. I love his writing and it seems that everyone remembers that. To the point where I had doubles of two of his books at one time.
  9. Lurlene McDaniel. They are remnants of my childhood that I am re-reading on occasion, but the are present in multiples.
  10. Clive Cussler. Okay, none of these are mine. In fact, I haven’t read any of his books, but Patrick has a whole hoard of them.

What author’s books do you have a lot of on your shelves?

How Did That Happen?: Surviving Call

I am way overdue for a How Did That Happen? post yet again.stethoscopes1

This week’s How Did That Happen? is all about surviving call. I did buddy call last weekend with our new first year resident (did I mention I love teaching?) and I have been briefing our other junior resident about what to do in certain situations and stuff like that. It had me thinking back to my first full weekend call as an R1 and my first gen surg call (shudder) and all that good stuff.

  • Like anything else, show up and do your job. Seriously. I have met some mighty lazy people who just want to slack off or get others to do the work. Other people notice. It makes you look bad. It puts patients at risk. And if the other staff get wind of it, they can make your life pretty much miserable.
  • Answer your pages. This goes along with doing your job. I mean answer your pages when you get them. Don’t make people wait if you can help it. Nurses notice if you’re being a jerk and not answering. They will also take pity on you when your pager stops receiving pages in the middle of the day and you failed to answer them the first two times they called (true story, my pager decided to konk out this weekend for about 4 hours… The fact that I am usually answer saved me from a ton of trouble).
  • Trust your nurses and allied health professionals. They are my superheroes. A good nurse can tell when things are going south and give you tips and suggestions when you are new and unsure.
  • If you are rounding on inpatients you don’t know, take the time to skim their chart and figure them and their current issues out, especially if they look unwell.   It can save a world of touble.
  • Before you leave after rounding, ask the floor staff if there is anything else you can do. Sometimes it creates work, but most of the time, it saves calls and it is the polite thing to do.
  • Get handover. I’m serious. It is a huge safety issue. Even if people aren’t seeking you out to give it, check with the regular team if you can. If someone is unwell, find out what the regular team would want you to do in the likely scenarios. Ask for that plan. If they don’t know suggest something. Going in knowing what to do about certain expected issues can make life easier.
  • Give handover. This is the safe and polite thing to do. Find the person coming on the next day and tell them either in writing or in person what happened to their patient, especially if it something that changes the plan.
  • Know who you are on call with. If you are a resident, you will always have at least a staff person on with you. Often, a senior resident too. Know their name and number in case it is asked of you or you need to get in touch with them.
  • Keep notes. Notes about the patients you need to give handover on, notes about things like outside calls. All that good stuff.
  • Ask for help. There are situations that you just can’t handle on your own. Or you aren’t sure of yourself. Do the best you can, but ask for help. Try to know what your plan might be, but admitting you don’t know or trying to figure something out is good learning and much safer.
  • If someone offers to lend a hand, take it. Sometimes, I had more senior residents tell me to text them if something weird came up that I just wanted to run by them. I was immensely grateful to just bounce a plan past someone without having to always run to the staff, especially when it was something simple that I was just new at.  
  • Sleep/eat when you can.  I feel like I say this often. But, I have been burned many times by staying up to wait for that last call or waiting to eat at a certain time. Just do it.
  • Some nights just suck. You can’t do anything about it. Just count down until it is over.
  • Bad stuff will happen on your watch. Someone will die (both expectedly and unexpectedly). Someone will get worse. Something crazy will happen (like a piece of suture hanging out of a drain that nobody can explain). Someone will hate you (because you told them they needed something they didn’t want). Someone may come at you with a weapon (people get creative sometimes).   Someone (including yourself) will make you look stupid (for instance, no matter how many times you tell a certain nurse not to do chest compressions because the person has a pulse and you need to manage their airway because they aren’t breathing, if the code team arrives and that nurse is still doing chest compressions despite your repeated attempts to tell her to stop while you are trying to ventilate because she just wouldn’t listen, they will still think you are the fool because you were “in charge” and it wasn’t even your patient, you just happened to be down the hall and arrived on the scene a minute before to help) know that. Learn from it.
  • Sometimes, you just have to go curl up in a ball and cry because the badness is just too much. Other times, you have to beat the pulp out of a pillow. And at times, you will need to leave a room to laugh your face off.
  • That paniced feeling of not having a clue what you are doing subsides. I don’t know when it goes away. I’m not there yet. It still comes in waves.
  • Have good references on hand. Don’t be afraid to look stuff up.
  • Prioritize your time. There are times where you are pulled in a million directions. Know what needs to get done. The sickest people are your priority. Computers and phones make good friends to help with reviewing results and doing quick orders.
  • Document stuff. Because, as above, bad stuff will happen on your watch. So does good stuff. The medical record is important, both for patient care and legal purposes. Plus, the day team will appreciate knowing what all went down.
  • If you are sick when you start call, odds are you will be sicker when it is over. One night, the nurses on a certain unit found it both sad and humorous that over the course of the night, my voice disappeared and my cough/breathing progressively got worse than half the patients I was managing. The whole illness being worse at night is amplified if you don’t sleep.
  • If you do home call, don’t forget things like your stethoscope. Nothing is worse than carrying your tired body back to the hospital at 3am only to realize you have to use one of the crummy “fisher-price” stethoscopes because yours is in your other bag.
  • If something can wait until morning for the regular team to take care of it, then let it wait. They might have a plan you weren’t aware of.
  • If you feel annoyed at that 2am call for Tylenol or a sleeping pill, just be glad it isn’t a new onset fever in a chemo patient or wound dehiscence.
  • Hospitals often have mice or rats. They come out when normal people are sleeping. Brace yourself.
  • There is a rule when it comes to call… If you have big plans the next day, stuff to get done, etc. it will be busy.  That being said, always bring something to do if you have down time.  But, know it will likely be interrupted.
  • Phone chargers and tooth brushes make the stay in hospital much better. So does take-out!

What are some of your surviving call tips?

Top Ten Characters I Would Want On A Deserted Island With Me

This week’s Top Ten Tuesday with the Broke and Bookish is kind of adventurous. They ask for the top ten characters I’d want on a deserted island with me. I’m not sure I’d want 10 other people with me if I was on a deserted island and yet, there is safety in numbers.

  1. Katniss Everdeen from The Hunger Games I’m sure she’ll be on a ton of lists this week. She really is a great person to have along. Good at hunting, great with a bow and arrow and experienced in survival.
  2. Finnick Adair from The Hunger Games He is a bit crazy, a bit intense, but he can do a whole heck of a lot when it comes to surviving.
  3. Hermione Granger from The Harry Potter She is ridiculous smart, is used to hanging out with humans and heck, she is magic!
  4. Brian Robeson from The Hatchet. This kid survived alone after a plane crash. He has to be good to have around.
  5. Four (Tobias Eaton) from the Divergent I like that he does his own thing, so I think that would make him easy to get along with. Plus, he isn’t scared of very much.
  6. Augstus Waters from The Fault In Our Stars. This was a suggestion from Patrick and I think it is a good one. He would make for excellent comedic relief and entertainment. This would work best if he were healthy. Or at least medically stable at the time of deserting.
  7. Marley from Marley and Me. Again, great comedic relief. Plus, a dog might scare away some nasty critters.
  8. Pi from Life of Pi. He would be interesting to talk to and philosophize with. Plus, he has some epic survival skills.
  9. Robinson Crusoe from the book with the same name. He seems experienced in the deserted island field of things.
  10. Lena or Tibby (or both) from The Sisterhood of the Travelling Pants I think I would get along well with either of these two. So, I figure I might as well get some friendship on this deserted island adventure.

What book characters would you want to be stuck on a deserted island with?

Nacho breakfast, unicycles and cat. Some random updates.

We had friends visiting from that lovely island where we once lived this weekend.  It was great minus the fact that I was on call (minor detail).  Thus the absence yet again of blog updates.  So, here are some random updates…

Our cat is currently trying to chew his way into a giant Costco box of garbage bags.  We think (and hope) it is because he can smell his cat food on the box.

There are some people in your life that you can just pick up where you left off… Even if you haven’t seen them in two years.  The people visiting are precisely some of those people.  

We played a new game this weekend basically about swimming robots.  What more can you want?

Image from amazon.com.

I got hit in the face with a chunk of tree walking in our tail of a hurricane weather a few weeks ago.  Instead of being distressed or mad… I found it funny.  

I saw someone riding a unicycle down the street the other day.  That is something that always makes me smile.

My cat is out to kill our cilantro and our carpet.  He has knocked the whole pot over three times.  I think the cilantro is now dying. 

Some person or group in our city hung random red swings from trees in various places.  I really want to find one and swing on one.  There is one right by the hospital.  One day, I will do it.

When I see a hopscotch thing drawn on the sidewalk, I almost can’t resist hopping on it.  Almost.

My to do list at work is an expansile mass.  But, it is a colourful one.

I drew lungs on a piece of my patient list this weekend while teaching the new resident on call.  Patrick saw the drawing and asked why I had lungs on my paper.  I was super impressed that he identified the body part!

We went to a wildlife park last weekend and saw a ton of peacocks just wandering around.  They screech like mad, but are kind of entertaining to see.photo

Nachos can make a good breakfast.  Especially if you are on call.  At least I think so.

 

A Resident’s response to “Think Medical School Is For You? You’re Probably Wrong.”

Think Medical School Is For You? You’re Probably Wrong. (From the Globe and Mail by Katherine Sinclair)

I found this article on my Facebook news feed today and I read it.  At first I agreed with it.  Then it kind of bothered me.  I think I am in the middle when it comes to this piece.

You see, I do agree that lots of people go in to medicine because it is the next step.  It is what people expect.  That being said, I think the same thing can be said about people going into Master’s and PhD programs, people going to Law school, etcetera.  If you are bright and do well, people expect you to keep going.

That doesn’t mean you are doing something blindly.

I also agree that lots of people say their motivation for going into medicine is “to help people.”  The real reason why is a good think to think about.  That being said, sometimes this kind of decision isn’t always made of a cut and dry reason.  To help people…  That was partly mine.  And yes, many people secretly want the prestige or the money.  I can honestly say that wasn’t really mine. At least not the money part.  Prestige, sure, I guess.  I wanted to prove I could do it.  But, after I have done it I hate being called “doctor.”   I seriously wanted to help people and do more and differently than I could as a Nuc Med Tech.  Could I have been a nurse?  Sure.  But, I wanted to be on the technical side of things and the care side of things.  Medicine made the most sense for me.  

Does motivation have something to do with the happiness of people?  Sure.  Do people who went into medicine not knowing what they got into get screwed over?  All the time.  I think that is more of an issue of the screening process and education process. People should know what they are getting themselves in to.  Life experience counts for something just as much as grades do.

Most medical students get used to no longer being “the best” when they hit med school.  People start failing then.  It is a shock to the system, but again, I think not different from other professional degrees. And yes, that sucks because you are used to being the best wherever you were before.  That is life, though.  

Life experience is super important.  People skills are even more important.  People who are good with people, who are willing and able to help and not afraid to get a bit dirty and involved do well.  Grades don’t beat good bedside manner.  That is a fact.  It shouldn’t be shocking, but I get that it can be for some people.

That being said, most people don’t like not hearing “good job” and being at the bad end of interactions time and time again.  I agree that this is the case in many internships and isn’t that different in medicine.  Lots of jobs are thankless.  I agree that this is part of life in that kind of position, but that doesn’t make it right in any field.  

I also have to argue that the culture in medicine is such that people are often (historically) made to feel stupid in order to “learn.”  That the apprenticeship is more trial by fire.  I don’t know what other professions are like, but talking to friends in other fields, it is more ridiculous in medicine.  It is a real problem.  It is getting better, but it is still real.

I have to argue that although I was used to being “the best” and I don’t like failing, it doesn’t crush my soul.  I feel disappointed.  Some days I cry or feel bad.  I’m not just a spoiled child who is trying to avoid the real world by prolonging my education.  I am fully aware of real life.  I had jobs to pay for school, I paid bills and lived on my own.  

Its true that you can’t fail.  Once you’re in, they might make you repeat things, but most people get through and come out the other side as a doctor.  And then, they do a residency.  They might have to repeat a few rotations and exams, but most people come out a practicing doctor.  I think that is a huge issue.  Huge.  Some people are crappy doctors and shouldn’t be doctors.  Fact.

I can only imagine if you are someone who went into all this not knowing and not really wanting to do it, they would be more depressed and unhappy than someone who is happy in their job.  It just makes sense.  But, that happens in any career.

The suicide rate is ridiculously high in young physicians.  The burnout rate is too.  There is a problem.  I think it is both in the system and in the students.  That there isn’t a good, safe out when you get in med school.  That it is bizarre to change careers.  That we have to be perfect and are kind of used to that.  

I agree that medical school is not the right place for many people, including some of the people that get in.  I have worked with people I have thought must hate their jobs.  We really need to think about who is getting in (and who is not) as well as the system issues and hospital culture.  

Medical school should not be a defacto next step.  It drives me crazy when people assume they’ll do med school because they are smart with no foresight about what it really involves.  It also drives me crazy when people generalize me to that group of people.  

That being said, people getting in for the right or wrong reasons does not account for all of the issues that are being brought to the forefront with residents and young physicians. The medical culture is a fascinating entity.  The statistics should be an impetus for change.  And those of us in the system need to be part of that change.

As I said, I don’t fully agree with the article, but it makes some good points. Med schools are making some changes to admission criteria, but I think education before applications are in is key to making sure the right people apply and get in.  People need to really think before they make what turns into a life long commitment.  

 

My Top Ten Favourite TV Shows

This week’s Top Ten Tuesday with the Broke and the Bookish is a top ten list of nonbookish entertainment… Like movies or TV shows. I am going to focus on TV shows.

  1. New Girl. I quite like Zoey Deschanel. I like quirky hipster geek stuff, probably because that is what I kind of identify with. The show cracks me up because it is so ridiculous and yet so possible.
  2. Gilmore Girls. I started watching this show because my Dad was watching it. True story. My Dad. Because Rory reminded him of me and that was funny. Eventually, I grew to like it. I love the banter and the pop culture/literature references.
  3. Everwood.  Most people don’t know this show, but it is a pretty unrealistic show about a neurosurgeon turned family doctor who moves his family to a small town after his wife died. I loved the show when it was originally on and Patrick just got me all 4 seasons for my birthday last month.
  4. The Big Bang Theory. I love the geekdom that is portrayed on this show. Maybe because I exist in a world working closely with physicists and maybe because I love weird bands of nerdy misfits. Even more than that, I love Sheldon Cooper.
  5. Grey’s Anatomy. I mock this show all the time. I get angry at the TV, annoyed with the drama and I keep watching. I watched it from the pilot and at this point, I am just way too emotionally involved to stop watching.
  6. Modern Family. I like that this kind of reminds me of sitcoms from childhood, but with a few twists.
  7. Community. I am so excited to hear that they are going to do a 6th season on some internet based TV site. I went to a community college and I truly believe that some ridiculous stuff happens there. I know the show is over the top, but it is a brand of over the top I can deal with.
  8. The Cosby Show. This is a show that whenever it appears on re-runs, I will always want to watch it.
  9. Full House. Again a show that I will always watch in re-runs. I grew up on that stuff!
  10. Derek.  I love old people in both books and TV. This is a fantastic comedy about life in a nursing home with some bizarre characters. It is British and the seasons are short and apparently stopping after 2 seasons (sad face) but I quite liked it.

What are some of your favourite TV shows?

The Annual M Event

We went on mini vacation to the M family reunion this weekend. I do better with it every year.

I think I am getting used to bigger family. I also think I am learning my limits and not pushing myself to do everything with everyone.

I stayed at the cabin by myself after dropping Patrick off to meet his family for the second drive in movie. I found a hatchet in the cabin. I didn’t know whether to be comforted I had a weapon or terrified who left it there.

Saturday was a beach day. I hit the beach for a run first thing, then spent the day there with everyone reading and swimming and capturing marine life.

We played mini golf that night. I beat Patrick and tied for third. It was thrilling.

Sunday was a day for leisurely travel. Spent time relaxing in the morning. We even stopped at a wildlife park!

Good trip. Despite the sunburn that I got even though I applied my SPF 30 every 2 or 3 hours.

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How Did That Happen?: How to overwhelm the pulp out of a new resident

I have been off my blogging game.

I blame starting core Rad Onc.  I keep staying late and studying at night and all of that stuff.  Funny how when you are doing something you actually love you tend to work more.

I also blame summer.  The nice weather nights have us out and about meeting up with friends.  Last night, we had a hymn sing at the nursing home we volunteer at with our small group and then went out for ice cream.  Tonight was coffee with a couple we know from back home who recently moved here.  So awesome.

I am a week overdue on a How Did That Happen? post.  So, that is what you shall receive.  stethoscopes1

I have been spending my last week orienting and mentoring our new, delightful R1.  My How Did That Happen? is how to overwhelm the pulp out of a new resident (in case you didn’t already know).

**Note: This is kind of sarcastic and based on things that really do happen.  There are some things I think administration and faculty can do better with.  There are some things that I can’t see solutions to… Just facts of starting new jobs.

  • First of all… DON’T OVERWHELM THEM.  This is my for real advice.  This will fail.  Starting residency at baseline is kind of overwhelming.  But, bits of information at a time and having someone available as help and back-up is better than just slamming it all in a book or presentation at once.
  • Have multiple giant orientation sessions for the incoming residents from the university, the hospital.  Fill them with tons of information that is both useful and useless intermixed with facts about failures, crying and patients dying.  Make sure that it is unclear what is useful or useless and make it seem like terrible things will happen.
  • Make sure to start them on call the first day or so of residency.  Nothing is better than really starting out with a bang.
  • Send out various passwords and user IDs to different email accounts and expect the person to sort them out themselves.
  • Have a very not user friendly computer system with a million different log-ons, passwords and variations.  Review these in orientations, but don’t do any practical training, that would be too helpful.
  • Use four digit paging in a hospital where you have to dial 7 numbers that can differ between sites.  Expect new person to call you back promptly.
  • Let new people loose in the hospital without giving a tour. 
  • Take the new person a tour on a hot day after a full day of orientation to show them everything.  Realize that they will remember very little of this.  Do it anyway.
  • Leave them to figure out everything on their own.
  • Tell them all of your call horror stories.
  • Take them to visit the ward.  Show them where everything is.  Show them the charts.  Talk about writing notes, finding computers and how the rooms are organized.  Introduce them to the all of the staff on the ward who promptly start asking who they are looking after. 
  • Go to a session about how to use an EMR only for the radiation oncology patients and for radiation planning.  Use technical terms just to really keep them on their toes.
  • Give them the sickest patients. 
  • Ask them to read around everything they saw that day.  The list of topics totals a page.  Oh, and review the clinic charts for tomorrow too.  Hope you can work the disconnected computer systems!
  • Talk to them about booking vacation.  That is months away.  On rotations that “you just need to take vacation from.”
  • Tell them you are so glad to be done intern year, it really does get better (this can be good… it can also instil fear of what is yet to come).
  • Try to tell them everything they need to know ever in one day.  Or at least make them think that is what is happening.

 

What things happened to you that overwhelmed you as a new resident or med student or employee in general?

 

First intent to swim beach of the year!

We had our first beach with intent to swim adventure this weekend.

I specify because I like just going on field trips to walk around the beach or explore areas near beaches all the time.

It was still pretty post-tropical stormy, but it was hot out, so we figured the waves would be epic and the beach might not be crowded.

Problem was, we failed to factor in that ocean windy is different even compared to the harbour windy we live every day.

We also forgot that it is still really early in beach season in these parts and that tropical storm/hurricane just passing through would mean cold water.

We got to the beach and the sign read that the air temperature was 16 and the water temperature was 13.  

But, I am stubborn and Patrick is insistent.  We drove an hour.  I put on my bathing suit already.  We are going swimming!

Child and D dug a giant hole in the beach.  They weren’t as hearty stupid as we were.

You kind of felt this searing pain followed by numbness as you entered the water.  It was the kind of cold that made you think you might actually have a heart attack and die.  It was the kind of cold that numbed my still sore-ish toe enough that I couldn’t feel it even when I knew I landed on it wrong jumping in a wave.

The waves were awesome, though.  And there were no jellyfish (probably because the rough waters were murdering them all offshore.  

We might have only stayed in for under 20 minutes.  We might have had to change right after to try to get warm.  But we swam.  And that was awesome (so was Child and D’s hole.  It was as long as Child’s leg.).  Other bonus was that I didn’t get much of a sunburn because I didn’t stay in the water longer than the lifespan of my SPF fifty million and two.  Last bonus was that I got to read some of my current fun book.

I love the beach.  And I love summer weekends where I don’t work (even if I had to spend the rest of my night on clinic prep and reading).