Photographic evidence

While on my disappearing act from the internet world, I have been growing a baby and there is little evidence of it.  I kind of like it that way.

Because the Child is an awesome friend who just happens to be an aspiring photographer (I say she is one, she feels she needs appropriate education first, so fair enough).  Either way, she is good with a camera and she comes cheap (as in we paid her in ice cream and love), we did the whole cliche thing and had some “maternity photos” taken.

I love pictures.  I don’t love pictures of me.  And when you are 36 weeks pregnant, it is even more challenging to love pictures of yourself.  Just saying.  Plus, it isn’t like we are get photos taken people.  We are the kids that didn’t have engagement photo shoots and had the Child and Patrick’s Aunt take our wedding photos.  I wasn’t so sure about the whole pregnant belly picture thing.  The weekly belly picture thing was a definite no (although it would have maybe proved to some people sooner rather than later that I really do look pregnant).

Needless to say, after some peer pressure and parental convincing and some weird sort of gut feeling that told me I really should do this, we decided to do the photo shoot thing.

And you know what?  It was fun.  And not just because I got a nice scoop of peanut butter fudge crunch in the end.

So, here are a couple of the lovely photos from the adventure (photo credit to the Child who has a blog she doesn’t update here: https://everydaysnapsblog.wordpress.com).

Alternative

This article “What Do Doctors Say To ‘Alternative Therapists’ When a Patient Dies?” by Ranjana Srivastava appeared on my Facebook newsfeed yesterday.  I couldn’t resist reading it.  I think you should read it too.

First of all, it is clear I am a big nerd when this is the most eye catching thing I saw on Facebook.

But, the big reason it is eye catching is because I was curious what it would say.  And it said what I thought it would.  We say nothing.  We don’t talk about it with others.  We talk about it amongst ourselves.

It also echoed a lot of feelings I would describe having around alternative therapies.

I am probably one of the more “loosey-goosey” of the people in my department when it comes to alternative therapies.  I am touchy feely, I inherently trust people and I do believe that there is value in a lot of things we can’t or haven’t necessarily studied.  I’m that kid who did a presentation on medical marijuana in research rounds and concluded that it isn’t all bad and we really need to look into the stuff more because people are using it whether or not we think they are or should.

I ask people what they take over the counter or with supplements.  I explain why I ask.  You see, some products, although “natural” act in ways that counteract the actions of chemotherapies or radiation or other drugs.  Sometimes in terribly harmful ways.  Ways that make cancers not respond to treatments.  Or ways that make side effects worse.  I ask because I care.  Not because I want to judge you or make you feel foolish.

Actually, some of the drugs that we give people are “natural.”  Some chemotherapies are plant derived.  They are natural and very toxic, but when used appropriately can treat cancers.

I see nothing wrong with trying something different when nothing is working.  I see nothing wrong with adding things that have low risks of harms that may help.  I see nothing wrong with doing things that are healthy for you.

I do see something wrong with people who are encouraged to spend their life savings on a “miracle drug.”  When people risk their lives to procure enough cannabis to make the oil they were told online was a “cure.”  When people entrust their health to internet “doctors” and people who make a profit from preying on the sick and the scared.

Many of the “miracle” agents on the internet are anecdotes.  Sure, everything starts as an anecdote.  But, that is why things are tested, because we are often wrong and they are one-off events.

There is some laboratory in anecdotal data about cannabinoids.  I’m not refuting it.  I’ve read it.  But, there is no cold hard evidence for it as a cure for cancer in humans beyond the odd case.  Could it be coming?  Maybe… But that day isn’t today.  And there is cold hard evidence for other treatments in some cancers.

It scares me that some people believe the person that will make a fortune off of them buying their concoctions is more trustworthy than the person who makes the same amount of money whether or not they take the treatment.   It upsets me that people think I am the one brainwashed because I am offering medicine with evidence behind it, with the experience of time, the monitoring of governing bodies and the backup of provincial funding.

It terrifies me to know that supplements and some complementary therapies (not all) are not regulated at all.  In fact, often they aren’t even containing what they claim or have contaminants that can be harmful.    And people die from complications from these therapies.  Just like conventional medicine.  But in a lot of cases we don’t even know some of the risks.

When something claims to work almost all of the time or have no side effects… It probably isn’t for real.  Too good to be true is something I see a lot.  But people want it to be true.  And why not?  Some people have nothing left to lose.  But really, everyone has something to lose.

It also makes me sad that some of my colleagues think all complementary or alternative therapies are bad or dangerous.  It is scary to see people doing things we don’t understand, so I get it.  And it is hard to trust when people you cared for and gave your all for die, sometimes because they gave it all up for the wrong choice.

Miracles happen.  There are things we don’t understand how they work, but they do.  There are things we know do work and they scare some people because of misinformation or lies spread through all kinds of media.

When people forgo conventional treatments or risk counteracting treatments for something advertised on the internet or sold by an alternative provider, it makes me uncomfortable.  I’ll be honest.  When people die doing this, it makes me sad.

Complimentary and alternative therapies can be many things… I send people for massages, acupuncture, reiki and I think chiropractors do good work. I encourage spirituality and  and exercise.  I preach good diets and appropriate vitamin supplementation depending on need.   I think cannabis can be an option for some people for symptom control.  I am okay with you doing something else so long as it isn’t putting you or your treatment at risk.  I can’t stop you from doing something I don’t agree with or trust because you are your own person.  But, I can be honest and tell you why it is concerning.  I can review the evidence.  I can help you interpret it because I have a background in reading that kind of stuff when many people don’t.   I’d rather know than not know in any case because your health is important to me.  And I make no gains or losses by having someone take “my treatments.”

I just want people to be healthy and safe.

Conventional medicine can’t save everyone.  Neither can alternative medicine.

It is scary, but things go wrong.  Alternative therapies (namely the various supplements and drugs and cleanses) can cause a lot of problems.  But, we don’t talk about it when things go right.  We also don’t talk about it when things go wrong.

Talking would be a good start. Regulations would be wonderful.

There will always be people out there trying to make money and preying on the sick and vulnerable. Sadly, these people give everyone a bad reputation and are the source of my distrust and skepticism.  I know there are practitioners out there who think they are doing good and maybe are not.  That is where better regulations and research could make a change.  And I know there are practitioners out there doing amazing work with the best interest of the patient at heart.

An open mind is good.  Educated professionals are better.  But, I think that opening up the lines of communication between professionals but also with patients could make a movement towards making a difference.  At least in some cases.

A Haunting Encounter

Today, I had a class on incorporating the humanities in medical education.  We were asked to write a short piece of prose or poetry on a patient encounter that haunts us.  Hearing what others wrote was way to much for my hormonal psyche.  I didn’t share mine because I was too busy trying not to let anyone see me cry about the ones that were shared.

I am not a poet, but it kind of has a poetic feel, I think… Here it is…

You did your best.  You knew something was wrong.  You were low risk, they said.  But, now, you are sit in clinic and don’t know how bad it really is.

You are angry and scared.  You cry when I review what is happening within your body.  I am gentle, but I am up front.  Medicine is so advanced, but so limited.  

Together, we bring you down off that ledge.  We have a plan.  You know what is likely to happen.  Then, I point out you need to meet my staff.  To keep in mind that a chance for second opinion isn’t gone.  

Gruff and curt, he approaches.  The plan changes and you are confused.  There is no explanation.  Just a closed door.

I try to help you understand.  I feel a sense of loss.  Like I am free falling in a place outside of my control.  It can’t compare to what you feel.

You don’t want another opinion.  You trust him.  Because you trust me.

In that moment, I don’t trust me.

I go home and review the literature.  I think and think.  I talk to another staff person.  I am right.  There may be more.  But, how does that get approached?  Who is willing to speak up?  

Everybody talks, but nobody deals.  That seems to be the way sometimes.  The questions are brought up, but I wonder if they were truly dealt with.  They get swept under rugs that some of us can’t help but look under.

This time, someone did say something.  This time, something did change.  Somehow, the suggestions were accepted.

I was relieved.  I want the best for you.  I want the best for all of you.  But still, the whole thing is unsettling.

In the long run, will it be enough?  Will you continue to get the care you deserve? 

If I hadn’t been there, if you didn’t trust me, would it be different?  Would you have made a different choice?

Maybe it is enough.  But, I wonder if we could do better.  I wonder if it is my fault.  That my being nice, that we “clicked” made you not question, not request that second opinion.

I won’t know.  I can’t help but wonder it is my fault.  And I’m not even sure what “it” is.

Teacher, teacher

I’m doing an education elective this month.

I have almost always wanted to be a teacher (and an author).  Well, after I got over the wanting to be a vet (my parents quashed that dream when I was about 4 when they informed me that if I was a vet, I would have to take a bath every day) and work at KFC (I was a chubby kid who really liked the way it smelled, despite the fact that I was informed I would no longer like KFC if I smelled it every day… I didn’t even have to smell it everyday to develop a dislike for KFC as an adult).  Honestly, medicine came much, much later in life.

I realized as a teenager that I hate kids in mass, so perhaps teaching elementary or middle school was out of the question.  I also realized science was very fun.

Once I hit medicine, though, I came to this crazy realization that maybe, just maybe I could “have it all.”  Who knew doctors teach?

Probably most people.

But, the fact that it could be my reality blew my mind a little.

So, I have always thought teaching was important.  I tutored in med school, mentored new students, all that stuff.  And now, I am doing an education elective and launching some new education related stuff in my department.  It has confirmed that I want to teach more.  I think I might even start working on my masters in the next year or two (depending on how this whole juggling residency and baby thing goes).

The funny thing is about the elective is that, for the first time in a long while, it is like being a student again.  Sure, there is no call and my hours are a bit more set, but I have assigned readings and projects and assignments.  Plus, the studying/prep for my usual program academics.  I forgot a bit what it was like to be a “real” student.  I have a love-hate relationship with being like a “real” student.

My focus is suboptimal.  Lectures from 8-12 and 1-4:30  That is a lot now.  Friday afternoon half-day is like torture and that is just 1-5 one day a week.  Plus, the degree of interaction is much more than I’m used to.  Group work?  Heck, usually my whole program is the size of a group they have me working with.  Non-clinical assigned readings are novelties.  Doing assignments and writing papers are things I do much more rarely now, but they are becoming regular occurrences.  Presentations and teaching practice prep is similar, but different.  And then there is switching focus completely to study for my usual departmental half-day stuff and exams.

That being said, it is neat to learn more about being a better teacher.  And knowing that it is something I can do.  And will do.

Seeing the enthusiasm of the Med 1s in tutorial and how everything is challenging and exciting is super cool.  Learning about what always seemed to be the top secret world of designing OSCE stations and training standardized patients makes me realize how much goes in to our learning.  Finding ways to make things better for newer trainees is encouraging.  Even figuring out how and why I learn the way I do and how to make that work for me is useful.

Most of my friends are teachers.  Heck, I’m married to a teacher.  And I am realizing that in more ways than I originally thought, I am a teacher too.

I know, I’m a huge geek.  But, I’m okay with that.  Just humour me.

A long New Years themed questionnaire

It is a few days after 2015 has started, but I have never been one to celebrate festivities conventionally (Okay, actually I did stay up until after midnight, saw fireworks as the clock struck twelve, toasted the new year (with sparkling apple juice) and kissed my husband… That is pretty darn stereotypical, I must say). I saw this 2014 in review questionnaire (one of many) done by a few of the lovely bloggers I follow and I decided to play along. Warning: it is long-winded and reflective.

YOUR 2014

What one event, big or small, are you going to tell your grandchildren about?

Tough one… Seeing Wicked on Broadway. Getting to see/hear “The Creature” for the first times.

If you had to describe your 2014 in 3 words, what would they be?

Emotional, blessed and nauseated.

What new things did you discover about yourself?

I learned that I am capable of depths of emotion on both ends of the spectrum (joy and sorrow) at levels that I previously was unsure were possible. I also learned that taking time to do the things I enjoy or spend time with the people I love is something that I too often put off, so I am gratefuly that I am now starting to do that more.

What single achievement are you most proud of?

Does being in the middle of growing a human count? I’m mostly serious. But, if we are going with tangible obvious things, it would be having completed my research project and presenting it at a national conference (although we are still editing it for publication… Ugh.).

What was the best news you received?

That “The Creature” continues to be growing and healthy. After a long wait for a baby and especially after losing Elim and knowing how many others wait and pray for well little ones, I can’t help but be so grateful.

What was your favourite place that you visited in 2014?

New York. Hands down. Best early 5th anniversary and partly free trip ever! I got to see musicals, Body World and eat a lot.

Which of your personal qualities turned out to be the most helpful this year?

My high-baseline optimism.

Who was your number one go-to person that you could always rely on?

Patrick, obviously.

Which new skills did you learn?

I apparently got pretty good at microscopy according to my Pathology evaluation.

My countouring skills are getting better. Bring on the head and neck cases!

I am getting better at transrectal ultrasound (I know, valuable life skills here, boys and girls) and inserting needles for prostate brachytherapy. Cervical brachytherapy seems to be a bit of a slower go for me, but it seems like whenever I’m on, the cases wind up being super complicated, so I get stuck not doing much.

Today, I have realized I have also become pretty stealthy at putting on Jeter’s harness.

What, or who, are you most thankful for?

I am most thankful for the many friends and family, particularly our extended church family God has stuck in our lives. They have loved us through a lot this year and keep putting my focus back on what really matters (sometimes with some laughs and healthy distraction on the way).

If someone wrote a book about your life in 2014, what kind of genre would it be? A comedy, love story, drama, film noir or something else?

A dramedy? I think that might be a genre.

What was the most important lesson you learnt in 2014?

It is not my story, it is God’s story.

Which mental block(s) did you overcome?

The perception or belief that I’m not “good enough.” Its an ongoing struggle, but grace is the gift that keeps on giving.

14.What 5 people did you most enjoy spending time with?

This is challenging, there are many people with whom I enjoy spending time. I’m going to say C&C, A&P, K and M from our old small group (I know, that is 6). We got to have some special quality time with them for the first time in a few years and it was really enjoyable, meaningful quality time, even if it was brief. That doesn’t downplay the time we spent with many other very important people in our lives, it was just some of the most special time.

What was your biggest break-through moment career-wise?

When I started realizing that I could answer questions intelligently in teaching sessions and during my treatment planning exams and that I totally couldn’t have done that last year. I didn’t notice at first, but looking back, I can see how much I am learning.

How did your relationship to your family evolve?

I find myself more attached and concerned for my family and extended family as I get older. Probably because I keep learning how fragile life is and how important those people are.

What book or movie affected your life in a profound way?

The End of Your Life Book Club by Will Schwalbe. I don’t know if profound is the exact word I would use, but it made me think about my relationships with family, with patients and how I share my love of reading with certain people. It made me want to check out more books and to actually discuss them (instead of reading being a solitary activity).

What was your favourite compliment that you received this year?

It wasn’t a compliment. It was the most heartfelt hug and simply “thank you” from a patient’s husband.

What little things did you most enjoy during your day-to-day life?

I love coming home to Jeter who immediately “flops” and expects me to give him a good rub as soon as I walk in the door. I also love the time Patrick and I have when we do our individual Bible reading, pray and just cuddle and talk about our days before I go to sleep at night.

What cool things did you create this year?

I’m not that creative. Probably a knitted mug cozie (and then I lost the mug it fit on).

What was your most common mental state this year (e.g. excited, curious, stressed)?

I’m a resident, so stressed.

Was there anything you did for the very first time in your life this year?

I ran for 20 minutes straight. Brachytherapy insertions. I played Munchkin, Gloom, Love Letter, and several other games. I saw Wicked.

What was your favourite moment spent with your friends?

I’m torn between kayaking with L, C, Child and D in the summer or playing games and having a BBQ with C&C, A&P and K this summer.

What major goal did you lay the foundations for?

I’m continuing to be a resident, so a suppose that is working towards my major goal of one day having a real job as a staff physician.

I would one day like to run 5k straight. I know for many people that does not seem like a big deal, but I am NOT an athlete by any means. Before I got pregnant and super sick, I was up to somewhere between 1.5 and 2km without a walk break and didn’t need too crazy long for a break. But now, I went for my first run again last week and I can barely run for 3 minutes without starting to get hot and out of breath (it has been about 12 weeks). I know that I can’t push myself excessively now, but I want to at least maintain (or improve) my fitness, so that after baby gets here, I can keep moving in that direction.

Which worries turned out to be completely unnecessary?

Patrick always tells me worrying won’t make me taller. And he is always right. So, all of them.

What experience would you love to do all over again?

New York. The time we spent with our old small group friends. Our cabin adventure with most of the BIFFs.

What was the best gift you received?

I’m going materialistic on this one. Mr. Holland’s Opus, which was a surprise from Patrick who remembered me mentioning it was one of my all-time favourite movies, so when he stumbled upon it, he bought it and watched it with me.

How did your overall outlook on life evolve?

That is a deep question. I think I’m getting better at seeing how grace really plays out in our world and in our lives in all kinds of ways that are sometimes more challenging to see.

What was the biggest problem you solved?

I fixed our broken drawer. I know it sounds trivial, but Jeter broke that bloody drawer trying to get to the treats a couple years ago and I finally fixed it! Maybe not the biggest “problem” but definitely the best fix.

What was the funniest moment of your year, one that still makes it hard not to burst out laughing when you think about it?

When we were in New York, there was a voice on one of the subway trains that said “Please stand clear of the closing doors” who just sounded so happy while saying it (and also like a CBC sports personality). Patrick thought it was hilarious and would mock it and get even more excited if it was the voice on the train we were on. After getting back, we would still periodically announce “please stand clear of the closing doors” in that voice and crack up. Then, we noticed the elevator they are replacing in our building has a small automated sign that says that exact phrase. We lost our minds laughing at that.

What idea turned out to be the best decision ever?

Choosing to work Christmas Eve, so that we would have Christmas day to ourselves and more time to spend with family/friends at home over the New Years half of the break. We got to rest and relax, enjoy our alone time and our time with people (and even saw almost everyone we wanted to) and it was the best break we’ve had in some time.

What one thing would you do differently and why?

I would have accepted more help from people. I’m often reluctant to admit that I need help, but there were points this year where I was so sad or so sick that I probably should have taken people up on offers of breaks or a hand with things around the house or at work than I should have. I realize now that the past few months would have been a bit better had I maybe taken another couple of sick days or evenings to myself.

What do you deserve a pat on the back for?

I finished my off-service rotations in one piece and made it through the first difficult 6 months of core Rad Onc in one piece (half of which I spent drowsy and barfy) with people somehow thinking I am keen and have a good attitude.

What activities made you lose track of time?

Board games with our lovely gamey friends. I can lose hours playing good games with good people. Also, as always, reading. And I will admit, because I am a big dork, clinic prep and contouring are huge time sucks for me and often lead to me losing track of time.

What did you think about more than anything else?

Having children and not having children. I know it is so cliché for someone in my age and stage, but this was a seriously consuming issue for me this year in both the good and bad.

What topics did you most enjoy learning about?

I love my job and my field, so I enjoy learning most about oncology and everything that goes with it from how people (on both sides of the desk) cope with cancer and live with it, to how it works to the technical side of treatments. I have also been really excited to be learning more about God this past year.

What new habits did you cultivate?

I was doing decently at going to the gym before the morning sickness took me out. Hopefully, I can get back to that. Patrick and I have been doing better with prayer together. I have also been trying to be more intentional with being “social.” I’m not saying I am a social butterfly, but I am trying to have meaningful (or at least some) conversation with people more often in situations where I would otherwise have tried to hide out.

What advice would you give your early-2014 self if you could)?

I don’t know. I’m not always a good advice heeder. I would probably remind myself to be patient and know that tough stuff is good for growing and learning and that worry isn’t going to make me taller (even though Patrick did tell me that).

Did any parts of your self or your life do a complete 180 this year?

Not especially. My caffeine intake is probably a quarter of what it was previously, but that is the fault of mind-numbing nausea.

What or who had the biggest positive impact on your life this year?

Getting back to some important things. Like playing music again. Seeing and staying in touch with people who have been important in my life. Most importantly, seeing the thread of grace that God has woven in our lives.

YOUR 2015

What do you want the overarching theme for your 2015 to be?

Growing.

What do you want to see, discover, explore?

I’m excited to do my Med Ed elective and improve/develop my teaching skills. I can’t wait to meet “The Creature” and figure out all that good stuff that comes with parenting. I am always happy to go on adventures anywhere, even if it is just close to home for the next while.

Who do you want to spend more time with in 2015?

Our families/extended family. We see them more now than we did our first few years of marriage, and I want to keep that up. Plus, their presence is going to be super important as “the Creature” grows up.

What skills do you want to learn, improve or master?

I need to learn how to be a parent at some point. As I said before, I want to work on my teaching and I just plain want to keep working on my clinical knowledge and skills. I always can improve on how well I love my husband and others. Plus, I want to be more fit, you know, the whole running thing, as I mentioned. If I could finally learn to play guitar, that would be great, but probably kind of a lofty goal given everything else.

Which personal quality do you want to develop or strengthen?

I’m not sure exactly how to word it, but I want to continue to work on my time spent with others. I want to be more open to people and more loving towards them and less afraid of interactions.

What do you want your everyday life to be like?

I just want to find joy in the mundane. Because that is what life is made up of, those ordinary moments that add together to make up our days.

Which habits do you want to change, cultivate or get rid of?

I want to keep working on our prayer time and devotions as a couple. I also want to get back to/get better at being more active.

What do you want to achieve career-wise?

I really want to pass physics and radiobiology this year (lofty dreams), so that I can just sit in on them when I come back from mat leave without feeling the pressure to have to write the exams and pass them with a toddler in the house. Doing adequately well on my other in-training exams would be great too. I also want to finish all of my rotations up to the start of maternity leave, so that I only have one 4 week block left of third year when I get back.

How do you want to remember the year 2015 when you look back on it 10/20/50 years from now?

I hope I remember it as a good year, but really, it is just a drop in the bucket.

What is your number one goal for 2015?

Read 67 books. Just kidding. That is a goal, though. I guess it is just to love and serve well.

My flu shot soapbox

Please allow me to pull up my soap box…

It is time for what is becoming my annual flu shot rant (see here and here for previous).

I got my flu shot this week.

Unless you are allergic to it or have another medical indication to not get it, you should too.

I mean, we are all running around terrified of Ebola and really, afraid of getting sick in general.  But, most of us are too chicken (or cocky or ill informed or paranoid) to get a simple measure that prevents a common and potentially deadly illness.  It is simple, it does not make you sick and the risks are really low (you can actually get some similar complications at random or from a bout of the flu).

Just to point out some facts… You can get the flu shot if you are pregnant.  This came up at work the other day.  It is not contraindicated.  It is advised (I know, there is limited data on fetal risk because the population data does not suggest an issue, but if there was a giant issue, they wouldn’t be doling it out to pregnant women… That is bad PR and asking for a lawsuit).  You can also get the flu shot while on most cancer treatments if you time it based on the advice of your doctor (ao came up at work)ls.  It is free in a bunch of workplaces and also if you have a chronic condition that puts you at risk if you were to get the flu.

Last year, I had, at one point, 3 people in ICU on ventilators (aka life support) with the flu.  The FLU.  And they were all in their 40s-60s.  Not old people.  Not necessarily people who were sickly before.  Crappy luck.  Bad strains.  None of them had received flu shots.  They all survived.  Not everyone is that lucky…  I also had a patient I cared for on an oncology related service die from complications related to the flu during their cancer treatment.

I have watched people die or nearly die from the flu.  I don’t want to watch more.

I know the vaccine isn’t perfect. Sure, there are years where they miss the mark in picking the viruses, but they still do confer some immunity and other years they are spot on.  I know people don’t trust doctors because apparently we have been brain washed.  And there is limited research on each specific year’s vaccine (because they are basically similar with different strains).   But, I like to hedge my bets.  It is simple, quick, easy and has more evidence behind it than most of the stuff seen on talk shows.

Don’t kill my patients.  Don’t kill my family.  Get the shot, it is extremely unlikely to make things worse and it probably will make things better.

Rant over.  I’ll step down again for now.

 

How Did That Happen?: How To Get Ready For The First Day of Residency

It is just about the week before residency starts. I am remembering how stressed I was about getting started and all that lovely stuff.stethoscopes1

So, this week’s How Did That Happen? is all about how to get ready for the first real day of residency. Did I do it all right? Heck no. But, I feel like most people wish they had done something different in one way or another.

  • Relax. I know, it feels counterintuitive when a week from now you will be able to write your own orders without someone glaring over your shoulder every thirty seconds. Seriously. It hasn’t started yet.
  • Do some things that you really enjoy but probably won’t have as much time for when you start residency. Patrick and I went swimming and I binge read fun books. Everyone has a thing. Do that thing.
  • If you had to relocate, explore your city. I still feel like, two years later, I am still trying to figure this place out. That being said, it is nice to get started at least knowing where a good coffee shop is, where to find the gym, how to get to and from work and some good parks/shopping. I like traveling and exploring, so I liken it to being a tourist in your new home. This is something we didn’t do much because we were busy visiting with family and such, but looking back, I wish I had.
  • Take time to be bored. Seriously. Do nothing. Then, remember what that feels like. In the future when insanely busy, remember that feeling.
  • Sleep in. I think this one speaks for itself.
  • Spend time with the people who matter in your life (if possible). They got you through med school and they will get you through residency. Enjoy their company during the in between. We spent a lot of time at home-home between med school and residency and it was really nice.
  • Organize your life. The practical stuff. Make sure your change of address stuff is done, that your bills are in order and finish all of that heap of paperwork they make you do when starting residency. Better to do it now than when things are busy.
  • Find the things you will need to actually do your job when the time comes. When I started residency, the movers dropped our stuff off a few days before things actually got started. I did bring my stethoscope with me in the car, but it took a while to find a white coat (which I didn’t need because my university issues them) and my pen light and reflex hammer. Oh, and pens. I needed pens because they disappear in a move like socks disappear in a dryer.
  • Find some good references or download some good apps. Realistically, you probably already have them, but it is nice to have access to a quick reference about common emergencies and orders and such. And of course, a good drug reference.
  • Check your schedules and go to orientations and things like that. A lot of hospitals have required sessions before you officially start or there is social stuff. I hate social stuff, but the information is good and the food is free (very helpful given you probably won’t get paid for a bit).
  • Find out where to go and when you start… Check to make sure you can actually find your way.
  • It isn’t unreasonable to do some refresher reading before you get started about some common issues or topics you will see on your first rotation. Don’t use all of your time to do it, you can’t remember it all anyway. Plus, you have all of residency to learn everything you need to know. You won’t learn it before you start.
  • Know that being anxious is normal. At least, that is what they tell me. This is a big step. That kind of anxiety stops you from going rogue and harming people. Most everyone survives.

How did you (or do you plan to) enjoy or prepare the week before starting residency?

How Did That Happen?: How to try to be a good resident

This is the first edition of “How Did That Happen?”stethoscopes1

The first topic in question given the droves of people freaking out about starting residency (and in my opinion, justifiably so) is how to try to be a good resident.

Clarification… Good does not equal perfect.  Perfect is not real.

I feel like most people want to be good residents. I sure do. And from time to time I have been told I am a good resident. And from time to time I work with good residents.

How the heck does that happen? What actually makes a good resident? Do you have to be the freaky genius kid who gets straight As all through med school and doesn’t sleep and doesn’t have a social life? I sure hope not, then 99% of us will never be a good resident. Ever. A textbook answer would be to refer you to the freaking CanMeds flower, but if you went through med school in this country, you have the sucker memorized.

So, here is what worked for me and/or for other people who have been told at one time or another that they might be a good resident or who worked with someone who was probably a good resident. Clearly, this is not a be-all end-all list and there are some details for different specialties that may vary.

  • Go in to things knowing you (and no one in this world) is a perfect resident.
  • Sometimes, no matter what you do, bad stuff still happens.  People still die, preceptors still won’t love you and that evaluation won’t be outstanding.  Life goes on.  You just have to keep trying.
  • Show up. I mean really show up. Go to work leave only when your work is legitimately done. Attend teaching and meetings and participate where necessary.
  • Be on time. Just because doctors are famous for being late and you magically (somehow) have that title in front of your name does not mean you should take up being late. People notice and appreciate when you don’t make them wait.
  • Be enthusiastic. I get that people don’t all have ridiculously high baselines. But, try to feign interest in what you are learning, even if it is a rotation that makes you want to gouge your eyes out with small needles.
  • Read. Read a lot. Learn about the main topics and objectives you have for a rotation even if it is something you don’t care about. You’ll remember that stuff when it comes time to prep for exams and it stops you from looking like an idiot.
  • Know how your specialty relates to the one you are currently working with (if you are off service).
  • If some asks you a question and you don’t know, say you don’t know. Then, look it up because odds are they will ask you again and if you don’t know that time, they will be less than impressed.
  • Know your patients, but also, know your team. Nothing is more annoying than when someone doesn’t know who is following who, where a team member is or what time to round.
  • Teach. It is as simple as showing someone where to find something in a chart or explaining the rationale for a test to as complex as preparing a lecture. Not everyone is good at or wants to teach, but everyone has to do their part. Remember what it was like to be a med student or more junior resident and help a person out.
  • Look things up. Don’t accept what someone wrote in one note as fact. Check images yourself, cross check medications with the patient or bottles or pharmacy. Confirm timelines with old records. Just because someone else wrote it down doesn’t mean it is true.
  • When you don’t know, ask or look it up and share with others. But don’t ask just for the sake of drawing attention to what you know… That is annoying.
  • Be nice. Seems simple, but some people struggle with it. Respect everyone, answer pages and questions and really listen to the nurses and patient service workers. Same goes with patients and families. Even the crazies need someone to be nice to them from time to time.
  • Care. Not the same as being nice, but in the spectrum.
  • Be organized. This is tough for some people. Keep track of meetings, projects and paperwork whatever way works best.
  • Volunteer for stuff. I’m not saying do everything because that will kill you, but offer to teach or do presentations or look up some articles.
  • Write good notes and try to be legible. Nobody is asking for perfection, but if you can read it and it contains enough detail that the on-call person can figure out what is really going on, then it is good.
  • Give hand-over. I can’t believe how many people are terrible at this. I think it is because we don’t really learn it in med school. If you have someone who is sick or who has potential to need something specific overnight or is just plain complicated, tell the on-call person who it is, what is going on and what you think they should do. Same goes for telling the day people if something crazy went down at night.
  • Help out others. They’ll help you in return.
  • Seek feedback. This terrifies me because I don’t want to hear bad things, but the only way to be better is to know what is wrong. Some people won’t tell you unless you ask.
  • Many of the above can be summed up with this phrase, “take initiative.” If something needs to be done do it or make sure there is someone who will.
  • Don’t get too cynical.
  • Don’t disappear. Seems simple. Some people have a gift for this.
  • Don’t go rogue and start making out of your scope of practice decisions and doing crazy procedures without staff (aka don’t pull a Grey’s Anatomy or House, MD).
  • Don’t become a hermit. Friends and family are good. They keep you “normal” and happy.
  • Don’t give up things like sleep or food for extended periods of time. I’m not saying it won’t happen, but if you have a choice, please choose these. They make people function better and keep people from being shangry (that is my new made-up abbreviation for sleepy hungry angry, something I am at about 8am after every in-house call shift).

What are your “how to try to be a good resident” tips?

Books I Almost Put Down

This week’s Top Ten Tuesday with the Broke and the Bookish is the top ten books we almost put down but didn’t.  I like this one because I tend to read books despite them starting to shape up to be awful and sometimes it works out, but others I really probably should have just put the book down.
  1. The Secret History of the War on Cancer by Devra Davis.    I have been reading this book very slowly for the past 3 years.  I have put it down at least twice for a period of a few months only to pick it back up.  Now, I am reading it for bedtime reading on those nights or days where I am in bed and want to read but didn’t bring my current book with me.  It isn’t bad, although, it is very conspiracy theory-ish (and with good reason).  I just find it gets to me a bit much and can be choppy at times.  I continue to be glad that I am sticking with it, so I count that as a win.
  2. The Host by Stephanie Meyer.  If I could get my time back, I probably wouldn’t have read it.  It was a bizarre concept and very full of love-triangle and implausibilities, both of which I hate.  It didn’t get better, but the win was that it didn’t get any worse.
  3. Sarah’s Key by Tatiana De Rosnay.  This book was SO SAD that I wept through almost its entirety.  When I first started reading it (and crying) Patrick tried to convince me to put it down and I refused.  It did not get any happier.
  4. Wuthering Heights by Emily Bronte.  I barely got through it in high school.  Just too much angst and bitter for me.  The second read was better, but there was still a point when Catherine and Heathcliff were old enough to torment one another senseless or when the narrator got rambly, I wanted to put it down.  It is a good book.  I would say it is worth the not putting down.
  5. Emma by Jane Austen.  The drama got confusing at times and when I got confused, I would get frustrated and want to put the book down.  That being said, my drive to actually figure out what the heck was going on and who was with who and such overwhelmed the book putting down urge and kept me reading.
  6. Red Rising by Pierce Brown.  This is one of those books I am so very glad I did not put down.  After the first chapter when this dystopian universe was being set up, I was bored by the mining stuff and such and was tempted to turf it.  But, I couldn’t justify putting down a book because of the first chapters (that took me a week to read because of interruptions).  The book was far better than the first pages.
  7. Exit Papers From Paradise by Liam Card.  I should have put this one down.  When you realize that the main character is a psychopathic narcissist, it should be a sign.  The most satisfying (and yet dissatisfying part) is that **spoiler alert*** he dies in the end.

That is all I have for now.

What books did you want to put down, but chose not to?  Was it worth it?

What is one thing?

What is one thing you can’t live without? That thing that would send you into a downward spiral if you lost it? That thing you need for your life to feel fulfilled?

Think about it for a minute.

That was a question we’ve been discussing in church and D-group the last couple of weeks. It makes my head hurt and yet has opened my eyes to how I perceive my reality.

My first instinct was Patrick. I can’t live without my husband.

But, I can live without my husband.

My second instinct was children. I want children. Living children.

But, I can live without children.

The list goes on… My family, my friends, my career, my home, my health.

Losing any of those things could send me on a downward spiral.

What does that say about me? What does that say about my faith?

Life goes on despite monumentous loss. We survive these things that we often can’t even fathom. I see people dealing with these things every day. How do we do it? How do I do it?

I know some people say strength and fortitude and a positive attitude.

I am talking about deeper purpose and something bigger than just getting through.

I know some people will disagree, but that something is Jesus. And maybe I am hum drum, but I don’t feel like I can find meaning in all of life and things without Him.

The passage we were looking at is John 6. It is a long sucker, but the cool part is that John is really intentional in his writing. He doesn’t include irrelevant details and generally stuff goes together to kind of show some bigger point about Jesus. He wrote the book, so that people would believe, so that makes sense.

This is the loaves and fishes chapter. It is also the walking on water and calming the seas passage.

I have seriously heard those stories a thousand times, so what is the big deal?

Well, check this out…

When they found him on the other side of the sea, they said to him, Rabbi, when did you come here?” Jesus answered them, “Truly, truly, I say to you, you are seeking me, not because you saw signs, but because you ate your fill of the loaves. Do not work for the food that perishes, but for the food that endures to eternal life, which the Son of Man will give to you. For on him God the Father has set his seal.” Then they said to him, “What must we do, to be doing the works of God?” Jesus answered them, “This is the work of God, that you believe in him whom he has sent.” So they said to him, “Then what sign do you do, that we may see and believe you? What work do you perform? Our fathers ate the manna in the wilderness; as it is written, ‘He gave them bread from heaven to eat.’” Jesus then said to them, “Truly, truly, I say to you, it was not Moses who gave you the bread from heaven, but my Father gives you the true bread from heaven. For the bread of God is he who comes down from heaven and gives life to the world.” They said to him, “Sir, give us this bread always.”

Jesus said to them, “I am the bread of life; whoever comes to me shall not hunger, and whoever believes in me shall never thirst. But I said to you that you have seen me and yet do not believe. All that the Father gives me will come to me, and whoever comes to me I will never cast out. For I have come down from heaven, not to do my own will but the will of him who sent me. And this is the will of him who sent me, that I should lose nothing of all that he has given me, but raise it up on the last day. For this is the will of my Father, that everyone wholooks on the Son and believes in him should have eternal life, and I will raise him up on the last day.” –John 6:25-40 ESV

It is kind of a ridiculous conversation. Jesus kind of talks in riddles (Is that blasphemous of me to say? I mean he really does kind of say stuff that comes off as bizarre and people don’t get him…) and the people He is teaching struggle with getting the point. Heck, even the disciples get kind of weirded out.

But this is what it is getting at (I am not that clever, this is what others say it is getting at and it makes sense to me)…

Jesus is enough.

Love the giver and not the gifts. You aren’t sustained (really) by things and relationships and all that stuff. In the end, even the thing you most want to cling to and think will make you complete won’t.

In essence, you can’t take it with you when you go. But when you go, you’re going to want Him on your side.

I like concrete things, so this is tough to process. How do I make Jesus enough. How do I stop being satisfied in stuff and people and start being satisfied in Him? How do I stop trying to fix and control things, but know that it is all completed through Him for His glory?

That isn’t something I just do.

In our conversations over the last little bit, our group has discussed that it is a tough thing to put into practice. It starts with having the desire (just like kicking or starting any habit, you need to want to start).

I’ve got that.

Action starts with awareness.

I have come to realize what I prioritize. What I think will fill me up and keep me content.

I am trying to remember that that satisfaction, although very real, is short lived and not complete. And that there is much more out there than having a happy marriage (although it is super important for a bunch of reasons).

Having real purpose and deep seated peace and joy is bigger than stuff. It is bigger than comfort. Sometimes we have to suffer well and know we aren’t alone in this.

Being sustained by Christ alone isn’t simple. It isn’t intuitive. And it is definitely by standards of our culture weird. But that’s okay (and I need to remember that).