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.

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I spent my birthday cutting up brains

Yesterday, I asked myself a strange question.

“If I told me __ year old self that I would spend my 28th birthday cutting up brains, would I believe it?”

Yes, it was my birthday.  And Patrick got me all four seasons of Everwood and I had surprise birthday cupcakes and bowling with the Child and D and I capitalized on tons of discounts and bought too many books with the gift card my parents gave me.  I ate a free donair and had ice cream and even got a real latte on a weekday morning (very luxurious).  It was a good  birthday as far as birthdays go, especially for me.

But, I did spend a chunk of my day cutting up brains.

As I have mentioned before, I am on a Pathology rotation.

As a result, I spent my birthday cutting up brains.

The last few days were neuropathology.  That meant, well, brain cutting.  Complete with a scalpel, butcher knife, forceps and a pancake flipper (to put the brain pieces we don’t use for slides back in the bucket for storage).

I suck at neuroanatomy.  My med school took it seriously, but I forgot all of it promptly after escaping the fumes of formalin that came to be known in my house as, “smelling like brains” (there is no better way to start your marriage than coming home to your husband “smelling like brains” and being told to go take a shower because you are that gross).  I need to learn it, but unlike the neuropathologist and neurosurg resident I was working with, I have to know the anatomy of, well, everything and learn other stuff too.

So, not only do I have poor manipulative skills, but I struggle to name arteries or know what structure is where (beyond the obvious, which are very different for me and for the pathologist) or what every structure does.  I did know these things.  Often it sounds familiar, but clearly not familiar enough.  And it doesn’t help when the other “learner” knows everything about brain anatomy.

I felt stupid.

It seems that is a trend this year, I have had a few rotations full of feeling stunned.  I hate feeling stunned.

Turns out, though, I am good at cutting the stuff up.  I follow directions well and have the right level of not caring about every little structure, but not butchering the right stuff.  My poor manipulative skills are improving.  Unfortunately, I couldn’t learn all of the anatomy over night.

I spent my birthday cutting up brains.

It is a strangely fascinating thing to do.  To see the anatomy first hand.  To try to figure out possible causes of death.  To start the process of confirming dementia.  To see how such small structures control such important things.

The brain stem.  The epicentre.  Where everything goes through.  It is just a bit bigger than a thumb.

The pituitary gland that controls all of our hormone production.  So small, you could lose it.  Pearl small.

Our bodies are so cool.

I spent my birthday cutting up brains.

When I was in Nuc Med, everyone made me promise I wouldn’t do surgery because of my terrible intention tremor and accident proneness.  I agreed.  Then, they were shocked to hear about me having to rotate through surgery.  Then, I had to do it again.  I am pretty sure cutting up brains (dead or alive) counts in what we were describing as surgery.

I still have all my fingers.  No harm came to anything or anyone (well, except my pride).

Patrick says that I was so weird as a kid and teen, I probably would believe I would cut up brains because I was strangely fascinated with the body.

Maybe.  But, once I hit Nuc Med and realized that I didn’t like surgery or cutting things up, probably not.

I spent my birthday cutting up brains.

Not many people get to say that.

I do.

That makes me really fortunate.  Even if it isn’t my favourite thing.

My head hurts (welcome to pathology)

My head hurts.

Translation: Welcome to your Pathology rotation.

Yes boys and girls, despite me swearing after my med 4 pathology elective that I would not do pathology again, here I am back at it for the last 4 weeks of PGY2.

Pathology is neat.  I like knowing what things look like and seeing stuff that causes disease.  I really enjoyed my rotation in med school.

I do not like microscopes or formalin.

Neither does my head.

I had hoped that because I am on different migraine prophylaxis, off combined OCPs and in better shape this would not be as much of an issue.  It isn’t as much of an issue.  Day two and no migraines, which is shaping up to be better than the first time around where I had a migraine on day one or two and every couple days thereafter.  But, I have had daily headaches.  And those are still not cool.

I need to drink more water.  And maybe getting back to the gym will help.

Perhaps this is just a blip and it will get better.

I have already learned a bunch and I can sense I will enjoy this pathology rotation even more than my med school rotation by virtue of how much I have already learned and how many teaching sessions and interdisciplinary rounds are going on.  Plus, my learning is targeted toward oncology, not entirely randomness. I am okay with spending my evening reading about gastric cancer pathology reporting and staring in microscopes half the day when it means that I will better understand the disease in the end.

I will have a good rotation.  Even if my head is trying to disagree.

 

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?

Reforming my inner plant killer

I am a renowned plant killer.

This someecards card could have my face on it.  Or at least it would have up until recently.

I learned this skill from my mother who also could not keep an indoor plant alive (outdoor plants were a struggle too).

This despite my grandfather and I having a garden in our backyard where we grew vegetables (okay, mostly onions and string beans because they could grow despite the crummy soil). And despite my Mom’s Mom being able to grow anything. She would come over to fix my mother’s gardens (true story), although now Alzheimer’s has caused her to also start killing all her plants too.

When I was working at the Hospice, one of the staff always cared for the plants. She went on vacation and told two of us to water them in ho[es that one of us would do it. We both did. Whoops.

When I was in Nuc Med, we had a class Christmas cactus. It died. Cactuses die too.  In my defense, I wasn’t alone in causing this death either.

So, by the time I got married, I declared my home a plant free zone.

Although, I did always want an aloe plant. I love aloe plants.

Patrick bought me this cute little flower plant my last year in med school. I somehow, despite many close calls did not kill the sucker.

We had to leave it there because we didn’t think it would survive the drive and boat ride in our very, very packed car.

So, after a year of no plants, Patrick bought me a rose plant. Because it can’t kill the cat if he chooses to chew on it (which he would). And because we can’t have aloe plants because they can kill the cat (sad face).

I told him that between the cat and I, it would die. Surely, it would.

But, here we are, a good 8 or so months later and the plant is still alive. In fact, it has grown. It hasn’t bloomed, but it has grown.

My rose plant in a new, more roomy and less leaky pot.

My rose plant in a new, more roomy and less leaky pot.

I’m evolving.

So, Patrick bought me an orchid (that is purple and beautiful and clashes terribly with our décor).IMG_0006

This brings me up to two plants.

So, yesterday, we were at Canadian Tire in the pouring rain waiting for them to fix our tire with an air leak. Turns out, there was a drill bit in it.   Anyway, it is far to rainy to walk to get coffee, so we were left wandering Canadian Tire and hoping we didn’t need to buy a new tire when I remember I wanted to get a plant for the rose bush thing because iti s still in the cheap plastic pot with pink foil around it.

So, I buy a pot. And some new soil.

And then we see the seeds and I comment that I always wanted to grow herbs.

So, what did we do?

We didn’t buy herbs.

We bought cat grass.

Yes, a plant of the cat’s freaking own.

So, this afternoon, I channeled everything I ever remember my grandmother telling me and I repotted my rose plant. And I planted the cat grass. And I remembered to give the orchid its weekly water.

IMG_0005

The pot of potential cat grass.

I haven’t killed the plants. And I haven’t killed the cat.

I am making progress.

And our house is becoming green.

When the weather gets better, we are seriously considering maybe growing some chives or coriander and maybe even some small vegetables or somethings delicious like that.

Maybe soon I’ll be a reformed plant killer.  It is still far too soon to tell.

Radi-what?

Today, I met Radiology again.  We meet daily on most of my rotations, but for the next month, we will be spending some quality time together.

It is new rotation day.  And my new rotation of the month four weeks is Radiology.

And just to clarify, in case you, like many people in my life, are thinking “That’s great, your home service,” the answer is no.  My home service is Radiation Oncology, not Radiology.  They are commonly confused.  Radiology takes pictures and uses imaging to take biopsies or put in certain devices.  Radiation Oncology treats cancers with radiation.

I have done Radiology rotations before.  I did job shadowing as a med student, then a full week in a summer med student program and two weeks of selective in fourth year med school and now this four week stint.  I have a whole degree in Nuclear Medicine.  A degree.

It is important stuff.  Seriously, without being able to read images and without the help of Radiologists being a cancer specialist, especially a Radiation Oncologist would be pretty freaking rough.

That being said, it isn’t easy to teach.  A lot comes from seeing the normal stuff over and over and over again.

And I have a ton I need to learn.

The thing is with Radiology rotations is that they are different from you usual clinics, consult or floor services.  You basically watch and listen to people do their jobs.  Sometimes, you get to try to do it too, but really, you are generally a bystander.  Because nobody wants someone random reading their CT scan without assistance.

Image from diagnosticimaging.com.

Because much of the day is watching people do their jobs, it requires consumption of mass amounts of coffee.  At least it did when I was a med student.  I am sure it will again.

Also, because it is a lot of watching people do their jobs, it is a lot of being told “Why don’t you go read for a bit and we can review the cases together later?” or “It is just boring stuff now, so you can go.”  And I get it.  I wouldn’t enjoy someone hovering and I wouldn’t want to feel like I was boring someone.  But, that is what I need to do to learn.

The good thing is that I have four weeks and lots of different things that I want to see and do.  Hopefully, I will accomplish it.  Plus, I can always go do some Nuc Med to make myself feel better inside from time to time (how often do you hear that phrase?).

That being said, it does also make for some excellent hours.

Pros and Cons of Residency

Residency is one of those things people don’t always understand.

Much like my messed up undergrad program split between a community college and university and the fact that I was a part of the International Baccalaureate program, so I did some university level courses in high school, it is something that can be bizarre to explain and a bit out of the ordinary.

I don’t expect everyone to grasp the every facet of my postgraduate training, but sometimes, it would be nice to not have to justify why I can’t go to party x or plan things months in advance because aside from taking a vacation day, I am almost never guaranteed a day off.

But one of the most puzzling things is that although I am done med school and although I do get paid to work in a hospital and have a kind of sort of medical license, I am still a student.

So many places ask me if I am here for school or work.  Both is not usually an accepted answer.  But that is the truth.

The bonus to being both is that I now have a decent income to not live in someone’s basement, but I still have a handy dandy student ID (with my name wrong on it…. I really need to go prove to the university that I am indeed married and have been for years) that enables me to get discounts, like 10% off my groceries on Tuesday evenings or 10% off everything at my new favourite café.

Another bonus to being both a student and an employee is that I can argue that I do indeed have a real job when people complain about “lifer students.”  In fact, much of the time, to outside people who don’t know me, I have just started saying it is my job.  It is just easier.

One of the best parts about residency is that I get to keep learning.  Not that I would stop once I have simply a real job.  But, this learning is indeed promoted.

Unfortunately, with promoted learning comes the need to study and do assignments and the favourite thing in medicine these days, presentations.

Yes, I have homework.  That blows people’s minds.  I work on average, 50-70 hours per week and do homework.

I love presentations (seriously, I am not right in the head).  And reading.  But, sometimes amidst the schedule of the excessive hours or erratic hours, these other things get a bit ridiculous.  I have online coursework to complete, evaluations to finish, reading for my actual rotation to do, stuff related to our physics teaching to learn and presentations to prepare.  It gets a bit excessive.

Would I have it another way?  Probably not.

I am lucky to have so many learning opportunities and this year, my home program only requires me to do one really big presentation and it happens to be during one of my less time consuming rotations (though I would argue, the constant schedule changes consumes more time thanks to sleep pattern flaws and headaches).

But, as I sit here writing reflective notes on talks about handover practices, professionalism and such, surrounded by papers all about soft tissue sarcomas and emails reminding me to complete evaluations, sometimes I just wish I would kick back and snooze on a chair without a care in the world (like Jeter is doing near me).  But I can’t, and I have learned that this is for the best, as I get kind of squirrely when I get bored.

Patrick keeps putting his winter coat on the chair and Jeter really likes sleeping on it.  On a side note, this is odd because Jeter rarely sleeps curled up.  He is more of a sprawler.

Patrick keeps putting his winter coat on the chair and Jeter really likes sleeping on it. On a side note, this is odd because Jeter rarely sleeps curled up. He is more of a sprawler.

Oh, and along with learning and not being bored comes teaching.  I always wanted to be some sort of teacher (at least most of the time).  And now I am.  I get to teach med students and other residents and other health professionals and patients.  It is wonderful.  Plus, it is promoted.  Very cool.

A con to residency is that I have to start paying back my student loans, even though I still pay some tuition.  Silly.  Good thing the government likes us and gave me a bunch of money off for finishing my degree in a timely fashion and adjusted payments because, well, residents aren’t THAT well paid (no doctor salaries here, at least not real ones).

My biggest con is the erratic schedule thing.  I change rotations every month or two.  That means a complete change in mindset and sometimes hospital and hours.  It gets better once things get more focused on my specialty.  Sleep is a hot commodity.  Time off can be as well.  You learn that you will indeed miss out on things in the outside world and that people don’t always understand.

But, anther positive to all of this is that things do get at least a bit better once this bit is done.  And you learn to appreciate your time more.  And sometimes when you are required to attend some events or learning sessions or even do call, there is free food involved… Free food is always a win!

So, I am thankful for a good program with helpful and delightful residents to get advice from, vent to and hang out with, a husband who doesn’t mind me being a bit bat crazy and family and friends who don’t always get it, but try really hard (or at least smile and nod).  I do like my new normal, whatever it is.   It is an opportunity not everyone gets and I am thankful for it.