Positives in the Tunnel

I wish I could say there is a light at the end of my tunnel of insanity.

But alas, there isn’t one.

Sometimes being a resident and a wife and having a life is discouraging.  Sometimes because it is so hard to do it all.

But, on a bright side to my frustrations, I do have a supportive program.  I may have a million expectations and things to do.  But, it is also a place where the staff person I worked with on call this weekend offered (insisted, really) to take my pager overnight for a few hours so baby and I can get some sleep.  And where I get encouraged to go to appointments and eat.

And I have a supportive husband.  Who picks me up late and is okay with a haphazard supper (again).  Who puts up with my hours of studying and pauses the TV when the pager beeps and who lets me take the car when I have a chance to go to a church ladies’ movie night.

Plus, I have outside friends who try to get it.

And a kind of cuddly and entertaining cat (with a bald spot that is finally growing in (that is a story for another time)).

And of course, I have a great Saviour who is the reason I can do and be all of these things and get through the day.

There are lots of things to be thankful for amidst the crazy.

Things that keep me up past my bedtime

In order of likelihood to do so…

  • My pager.
  • World Junior Hockey/Olympic Hockey
  • NHL playoffs when the Habs are playing.
  • Travel.
  • Visiting friends or family.
  • An exceedingly good book.
  • Homework.
  • Patrick.
  • Something highly intriguing on TV (including other “less important” hockey).
  • My mind on overdrive (especially dangerous when combined with pregnant uterus sitting on bladder).

My priorities are odd.  Its too bad we spent a week visiting friends and family that wrapped up with last night and tonight being hockey and tomorrow night being on call.  And usually sleep is so important to me (and my work is piling up).

Some someecards that describe this weird relationship the M household may or may not have with hockey.  Don’t judge us too much.

Whoo!  Go Canada!!

Thanksgiving Turkey and “Meeosh”

Yesterday was Thanksgiving here.

I was on call.  It is how I roll these days, it seems.

Despite that,  I thought it would be a good idea to have people over for Thanksgiving dinner.  Because we have a biggish dining room and I like to cook.

It was a good idea.

Some planning ahead and good luck meant that we had a lovely Thanksgiving dinner with Child, D and Dr. Bond.

I was ridiculously excited that I found a “decently priced” fresh turkey that was small enough to fit in our oven and the disposable baking pan that would also fit in our oven.

Jeter made it his main goal in life to eat the turkey.  He tried to eat it raw, he tried to pick the chunk of extra skin out of the garbage can and then, once everyone arrived, he proceeded to jump on the counter and try to steal a bite repeatedly.  That cat likes his meat.

I like having some “family” away from biological family.

I also like hosting Thanksgiving because it means we wind up with leftovers… My favourite.

Tonight we had what my family calls “Meeosh.”  The recipe: Take all of the leftovers, mix and fry them together in a frying pan, then put extra gravy on top.  Other people call it hash.  I call it delicious.  Patrick and I both looked forward to it all day.

Interestingly, Patrick had never had “Meeosh” until he married me.  In fact, he never had anything quite like it.  He thought us a bit odd that time as my Mom and I combined everything we pulled from the fridge in a giant frying pan.  He was pleasantly surprised and has never gone back.

Mmmm… Turkey.

The last few weeks in a nutshell.

When it comes to regular blogging, I have been an epic fail lately. Sometimes life is just plain busy and my priorties have been such that sitting down to write has not been a priority.

So, for those of you who care… Some updates on my last couple weeks in a nutshell.

The treatment planning exam I wrote about went decently. It was challenging. I got through it and my score was not good, but was good for a first exam. Plus, that means I met the milestone of doing my first treatment planning exam.

The Child and I started going to Body Pump classes. Once a week. But every week. For those of you who are regular Pump attenders, this may not seem like much, but it is a huge stretch for us to commit to going every week and getting stronger (even if it would be better to go more than once a week, I’d rather set a realistic goal). As a result of attending these classes, we have turned into bigger gym rat-like people, not only discussing our run times at times, but now also plotting out how we could go up on our weights or do a certain move better.

I went wedding dress shopping in a real wedding dress store for the first time ever last week with my sister-in-law. True story. I am married, but I bought my dress online from Sears. I lived away, so I didn’t go dress shopping with any of the friends that I know who got married. It was an experience. I feel okay with never having to do it again.

I am very excited to go see Gone Girl later today. The book freaked the heck out of me (once I got past the first ¼).   I expect the movie could do the same.

Patrick and I went to a produce store yesterday that is known for its ridiculous deals. We have had friends from church recommending the place for ages, but had yet to go. We now understand the beauty that it truly is.

My program changed our academic half days to Friday afternoons. It is a form of torture to sit through 4 hours of lecture on a Friday afternoon. Especially when you have a busy review clinic all morning and no time to see your inpatients until after all the teaching. I discovered caffeine and cookies help, but don’t cure the Friday half-day blues.

I had a post-call day last week because I was stuck in hospital until 2am with a spinal cord compression who, after we treated, started having “new” chest pain (that in retrospect wasn’t new) and then was called several times overnight. I was so excited to have a post call day. And didn’t even feel that guilty for taking it because the night was that kind of ridiculous. Then I remembered, post call days suck when you were actually up most of the night because you need to sleep. Silly.

I love treating head and neck cancers. Even though they tend to get so sick from treatment. And even though some of the patients are tough drinkers/smokers who don’t want to do anything they should. I like a challenge. And I really want to help. And we can cure people with this type of cancer, which is always cool.

My computer at work was giving me the blue screen of death and shutting down intermittently. It got to the point that I couldn’t get any work done and had to use someone else’s computer. The helpdesk person had no real explaination as to why my computer blew up in my face like it did. He had to reload everything back on it from scratch (and I lost everything that was saved on the computer itself (not much)). In retrostpect, I like to rest my feet on the computer console thing under my desk and twice in the last few weeks I accidentally kicked it over. That might be related. Whoops.

I have been attempting to read The Maze Runner for two weeks. Much like my blogging, life has gotten in the way of my fun reading. Silly.

I have been obsessed with listening to Needtobreathe lately. Not sure why, but their mellow has been drawing me in. Like this song:

What is new with you? Anything exciting?

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?

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.

 

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?

 

Happy Belated Canada Day and Residency New Year!

Yesterday was Canada Day.

That also means it was start of the new residency year day.

I am officially a PGY3  (well, I am still missing a few evaluations from PGY2, but barring surprise failure, I am a PGY3) and today is my first day of doing actual Radiation Oncology for the rest of residency (minus my medical education elective).  I’m a happy girl.

I started off my first day as an R3 on call.  I’m just festive like that.

It was a sunny, beautiful day.  Everyone and their dog was out for celebrations dressed in red and white and I was off to the hospital (also in red because for some odd reason, having to work made me festive).  I waded through seas of people coming and going to various festivities, dodged a parade route that they were closing strangely early and all of that good stuff before even 9 in the morning.  Getting coffee was a challenge because the first two places I tried were closed.  I had to settle for the very Canadian, but not festive enough to close Tim Horton’s (ugh).

The fact that it is home call, however, was good.  It meant I got to spend some of the afternoon sitting out on the deck with the husband and the cat watching the crazies and waiting for a page.  I even got a little bit of work reading done.  A little bit.  Oh, and we took a M family selfie.10480582_10152674222399316_5582227936371051593_o

Happy day late Canada Day and residency New Years!

How Did That Happen?: How to schedule in order to optimize both life and learning

I am spending this weekend on call.   And the first weekend that it has seemed really summery here. My timing is impeccable.Thank goodness for home call.

This week’s How Did That Happen? is about scheduling. I call it “how to schedule to optimize both life and learning.”stethoscopes1

I had this conversation with one of the other residents in the program last week about how to schedule vacation and calls and life to try to optimize learning and good quality time to do those things that we want to do. It is tricky to say the least. Sometimes it just doesn’t work.  t have something on the go every weekend in July, so scheduling call and church set-up duty and things this month coming were logistical disasters.

As usual, I don’t have it all figured out. And I am pretty sure there is no magical formula.

  • Not every rotation gives you the luxury of picking call or even requesting days to not be on call if you don’t have formal vacation booked. Sometimes, you just have to work on a certain day. Make the best of it.
  • If you get scheduled for call or a shift when you have something planned or something comes up, try to trade with someone. This may not work because others may have plans or may just be jerks. I have encountered both.
  • If you don’t have something on the go and someone asks to switch shifts with you and you have no good reason not to, switch with them. What goes around comes around.
  • Keep a calendar with important dates on it. Refer to said calendar in advance. The more notice you can give people of shifts you can’t take or time you want to request off, the better.
  • If you get guaranteed post-call days, make use of them. The afternoons are prime times to go to appointments, run errands or even travel (ensure sufficient rest if you are the one driving). Some of my best post-call days were used to go on café dates with the husband, travel home or get important shopping done.
  • Use call to your advantage. If you are lucky like me, your contract might stipulate that if you work on a statutory holiday, you get a day off in lieu. That means it is another day that doesn’t count against vacation time to use at another time (in my case within a couple months of the actual holiday). This is great for constructing a long weekend or getting an extra day to study or work on research.
  • Choose your vacation wisely. We are allowed to break up our vacation any way we want, so long as we don’t miss more than ¼ of any rotation. I have seen people take it all in the first couple months and then had nothing left or not used it and were stuck trying to take days excessively at the end of the year.
  • Being allowed to break up your vacation is advantageous in that you can take a day or two and tag them on to weekends you know you are off to make long weekends instead of just having one week.
  • Conferences are your friends. We get funding and time to go to certain conferences while some other departments might allow a cetain amount of tiem to go to whatever conference. They can be in really nice places and taking extra vacation around these can lead to you getting to enjoy a place you might not have otherwise had the time or money to visit while getting some learning in.
  • Keep in mind that things like exams and presentations are often scheduled in advance. Try not to be on call the night before and if possible schedule them at times where rotations and your life aren’t too hectic.
  • If you are married, both call schedules and vacation schedules should probably be run by the spouse.  Sometimes, it feels like we are a logistical nightmare, but every once in a while we have a scheduling “win” and get some extra time together.
  • You can’t do everything.  Sometimes you just have to say no to things.
  • You need to do something fun.  Try scheduling in mandatory fun time.  Or, if that isn’t an issue, schedule mandatory homework time.  Or both.
  • If you pick your call, try to do the same day every time, so it is easy to remember.
  • If you pick your call, try not to be on call before special teaching events or things you will end up missing if you are post-call.
  • Use your time wisely. Seems simple. But its not.
  • Know that despite all of your planning, something will go wrong. Your exam will get rescheduled three times, your relatives will die, you will get sick.
  • In the end, you will work about the same amount and be off about the same amount, so it is not the end of the world when something doesn’t work out. You win some and you lose some.