Evil Genius

Sometimes I feel like an evil genius. Not for especially good reasons either.

Image from cryhavok.org.

I feel like I beat the whole world because I took an in- lieu day and a couple vacation days to make an extra long weekend in early December to do all of that festive stuff that I need to get done.

It has become my routine during residency. The last few years, I took one day to get most of my shopping done. You see, I hate shopping at the best of times, and when Christmas comes and the crazies come out, it induces a kind of rage in me that is kind of terrifying.  So, I take a day off during the week and try to hammer out all my shopping while at least some of the crazies are at work.  This year, with the parasite, I decided it might take me an extra day or two and that I might have other stuff to do, so I took an extra couple days.

And thus, I hammered out all of my shopping, Christmas card writing and helped decorate the church plus I’m considering even doing some gift wrapping (if I can find last year’s wrapping paper…) before heading back to the world of work.

I even caught up on Grey’s and some other stuff I have been meaning to watch and cleaned out my closet! I may or may not have cried during both (for different reasons… I blame the tiny human).

Take that consumerism, festiveness and life! I can be festive and not want to die (it is sad how big of a deal that is to me).

Image from degrassiwikia.com. Interesting that this is from the Degrassi wikia page but is clearly a Boy Meets World scene… Fail internet. Fail.

Turning Tables – Treating Physicians

Today, one of the other residents and I had an interesting conversation.

Somehow, the topic of treating physicians came up.  And it is something that terrifies us both.  And not just for the reasons you might think.

I will confess, treating other health care people is always nerve wracking because you worry even more about saying something wrong or stupid because you always wonder if they are secretly judging your skills.

But the bigger thing is that when we see them, they are being faced with a cancer diagnosis.  And for some reason, most physicians and nurses get the bad ones and all the complications.   And that is horrible for anyone.

The issue is, they know too much.  Sometimes, having some uncertainty is a good thing.  But, when you have cared for people with the same thing.  When you understand the odds and get the treatments, it is a whole other level.  You know the worst case scenarios.  All of them. Sometimes the unknown bits of the known are the worst.  Especially when your whole world gets turned upside down.

That is the hard part.  The anxiety, the sadness, the anger and guilt.  The fact that sometimes, the person who knows too much coming in can’t be easily comforted.  That the numbers that scare everyone have too much meaning.

It also forces us to face our own mortality.

We both agreed that given we work in Oncology and given the odds in the world today, we will both one day have cancer.  And we will probably die from it.   Those are simply real odds.  And the “comedy” that is life.

And we know this and accept it.  In fact, we laugh about it in an uncomfortable kind of way.  Sure, I might have a heart attack or an accident, but it is more likely I get dementia or die of cancer… Or both.

Really, it is something I accept.  But, it is still something that is terrifying. And maybe that won’t happen.  Maybe I’ll just die in my sleep in old age.

Either way the reality of seeing people who dedicate their lives to healing others broken, afraid and unwell is terrifying.  They are “one of us” who became “one of them.  It is just too real sometimes.  Too close to home.

I just want to fix the hurt.  I want to prevent the hurt.  I want to be out of a job (kind of).

But I can’t.  So, we do the best we can.  With every person.  Because one day the tables will turn in one way or another.

Work in the midst of call

This weekend, amidst all of my call-y goodness, I am trying to get some work done on a few upcoming projects/presentations.

I have a journal club a week from Tuesday, so I picked some articles.  Head and neck cancer supportive care.  Look out world.  I’m about to critique the pulp out of an article on prophylactic versus reactive feeding tubes and hemoglobin levels and transfusions in head and neck folks.

And then, I spent a bunch of time looking into stuff for career day.  Every year, I help out with career day.  And every year, I say we will make it better next year.  You see, Rad Onc, much like me in high school, is kind of one of the nerdier, quiet and obscure specialties out there.  As a result, most people walk right past our booth.  Seriously.  You should see them all flock to the surgical simulators and fake airways at Gen Surg or Anesthesia.  And everyone wants to know how much the Radiologists make to sit in a dark room.  But, the Rad Onc folks.  They have creepy masks and a powerpoint.

Image from ebroc.com.

Not this year.  Okay, we will still have creepy masks and a powerpoint running.  That is who we are.  But this year, I am cracking out some YouTube videos of some of the “cooler” aspects (that’s right… big machines and computer animations).

They are cool to me.  And at least they give people something to ask questions about.

Plus, I think I have found an online application that we can use to make ourselves “interactive.”  A try your hand at contouring station, perhaps.

I know, not as cool as intubating a dummy.  But, maybe we’ll get to tell another couple people who we really are.

I just have to get approval from the powers that be (and acquire the technology to make it all happen).

Today I decided to clean out my email inbox instead of starting to actually work on the journal club.  Because that is just too much energy.

I got about 2 minutes in when I realized something.  I have something like 30+ One45 emails.

For those of you in the world who don’t use One45, it is an online evaluation system people in the medicine world love.  And we evaluate every single flipping session we ever attend.  And get evaluated almost as often.

Image from imerrill.umd.edu.

Usually, I’m on top of those things.  I hammer them out once a week or so.

The last two months or so, not so much.

I know what I’m doing this evening.  It involves a likert scale, good music and trying to reach back into the recesses of my memory.

The Happy In My Halloween

Today was a happy in my Halloween.

I managed to arrange for transfer for one of my patients.  It is always good to get people back to home hospital, but it is especially good when it also makes my day start off well.

I presented Morbidity and Mortality rounds today and people actually kind of participated.

It is Friday half day, which means an afternoon of lectures, which is tough at the best of times, but especially on Fridays.  This week, I was supposed to have Radiobiology from 4-5, which is the most potent form of educational torture there is.  Unfortunately, our instructor went home sick with the flu.  Fortunately, that meant we didn’t have that lecture and although it has to be rescheduled, I was glad to not sit through it at 4 on Friday.

Also in Friday half day, the radiologist who taught us an awesome head and neck lecture brought us Halloween candy.  And not just any Halloween candy… The good stuff with peanuts in it that can kill people but tastes soooooo good.

I realized in said head and neck lecture that I am finally beginning to figure out head and neck and knew things in the lecture.  It was an exciting “ah ha” moment for me.  And thank goodness it is starting to come together because I have a treatment planning exam this week and it is yet again on head and neck (the universe or at least my staff seem to hate me on this front).

Patrick and his class went on a field trip today and had a good party afterwards (complete with cookies he made last night).  I was impressed at his craftiness and ability to get through Halloween with a classroom full of third graders.

We went to a Mexican restaurant tonight for supper where I got to feed my most recent craving… Spicy chilli.  I love a good burrito.

It is Jeter’s “birthday.”  The anniversary of when we inherited him two years ago.  He threw up on the carpet for us when we got home from work and is now happily carrying around his new “birthday” replacement feather on a stick.

We are settling in for a night of watching Charlie Brown and other relevant specials while waiting for the kids that never come to our apartment. It is to bed early tonight for band and a day full of studying, house cleaning and a potential games night!

Happy Halloween!

Reblog: “In Defense of Doctors”

I read this the other day on a friend’s Facebook page and I liked it enough to want to share it with other people.  Check it out, it is called “In Defense of Doctors” by The Murrays.

In a day and age where everyone has information at their fingertips, it seems that distrust of the medical system is everywhere.  I work and function in that system every day.  I also am a patient in that same system.  I have to trust it.  I can be well educated and informed, but I go in expecting my physician or nurse or other caregiver to know their stuff too.  These people go to school for years.  They sacrifice their lives.  They don’t want to do stuff to harm you.  I’m certain of it.

I have on more than one occasion come home and worried about a patient I left at work.  Or spent hours scouring the internet for the right answer.  That is what it means to be in a caring profession.

Please trust that we care.  And we have your best interest at heart.  We sacrificed a lot to get here.  It doesn’t stop with you.

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?

Bear Hug

Some days, you wonder if you are doing enough, caring enough, loving enough.

You go to rounds and hear things like doctors don’t care or don’t spend enough time with patients.  And you sit there wondering how you can do more.  Because maybe, just maybe, they could be right.

You spend time researching to help someone.  You talk someone through even the simple things.  Sometimes you just make small talk because it seems right.  You stay late.  You go in early.  You think about them when you are home.

Then, someone you cared for dies.  And you get a big, tearful bear hug from the most challenging family member.

Suddenly, it is all worth it.  Suddenly, I believe it might just be enough.  Suddenly, I remember God put me here for a reason.

Head and Neck

I got an email with the topic for my very first treatment planning exam.

Aside… A treatment planning exam is an oral exam where we get grilled on our management of patients from presentation to treatment and follow-up to help us practice for our licensing exams at the end of residency.  It can include basic questions right up to referencing why we do treatment in a certain schedule and where a target its. They start in third year, which is where I am now.  They are supposed to start off easier and get harder as time goes by.  At least in theory.

The site is “Head and Neck.”

Agh!

My issue with this?

Head and neck is probably one of the most difficult sites to treat and master.

I mean, we don’t do much head and neck related stuff in med school or even the first two years of residency and then, bam!  I’m treating cancers there.

At least, I have for the last two and a half weeks of this rotation.

I like head and neck.  I have said it is likely a site I’ll want to treat.  That doesn’t mean I feel anywhere near confident in it.

And it is my first exam.

When I opened the email, I just cracked up laughing.

Apparently most people get something like bone metastases from another primary.  Nope, not me.

Maybe it will be more simple than it sounds.

But, I don’t feel optimistic.

It is going to force me to read more.  But, I really was hoping for a relaxing weekend home.

That is how life works.  And how residency works.

Learning is good.  Looking stupid is part of learning.  I just need to embrace that.

Thank goodness Dr. Bond gave me some notes and tips.

I just hope my examiners remember I’m just in third year.

How Did That Happen?: How Did My Job Eat My Life? And How Do I Make It Stop?

It has been almost a week since I last posted.  And what a week it has been…

For this week’s How Did That Happen?  I present How Did My Job Eat My Life?  And How Do I Make It Stop?stethoscopes1

Being in medicine is a time commitment.  I have heard people say it is a lifestyle or a sacrifice.  The guy from the bank who was trying to sell me a credit card called it those things and more.

Those were the last words I wanted to hear.

Usually I feel like my work-life balance is pretty good.  At least half decent.  But, the past few weeks before and after this conference, I am questioning that.  And this week, I had significantly more work than life.

So, how did my job eat my life?

Step one… Work with staff who seem like to take extra consults, at least at this time, and acquire sick inpatients.

Step two…  If something could go wrong with a patient, my computer, my schedule… It will.  And probably more than once.

Step three… The internet never has the information I am seeking readily available.  Clearly, I can’t find a good how to delineate a mediastinum on the internet.  Or good information on BRCA2 in men and cancer screening outcomes.   Lots of random stuff, but not what I want to see.

Step four…  Try to get things done in a reasonable order.  Suddenly everything less important will become a priority.  And get rescheduled.

Step five… Someone will send you an assignment for half day the night before.

Step six… The number of inpatients will increase nearly exponentially over the course of the week before you are on call.

Step seven…. Lose all sense of organization on your desk so that it is covered with papers that need to be filed, organized or shredded.  Get distressed by this whenever you sit at your desk then waste time trying to figure out if you have time to deal with it.

Step eight… Realize that your job has eaten your life and that you haven’t been home before 7 all week.  Then realize you are on call for the weekend.  And then worry about one of your inpatients such that you are up half the night even though you weren’t on call that night.

So yes, life eating has prevailed.

My plan to beat this is captured in this picture….

IMG_0429.JPGI’m on call… I can’t undo that.

But, I will win otherwise.

I will eat my delicious burrito and read a fun book tonight… Even if I take pages in between.

I will not work on research or study tomorrow or Sunday because it is already very apparent I’ll be at work a good chunk of the day rounding and admitting and all that stuff one has to do.

I will spend time with our friends visiting from home in between all of the work stuff.

I will say no to the second research project I already said I would work on because it isn’t something I am super excited about and I have other things that might come up.  I will not die because I said no to something.   I don’t have to say yes to everything.  And I was kindly reminded this week that not everything that is work or residency related is necessary because it may not meet my end career goals.

I figured out this week that if I go to the gym by 6:20, I can get a workout in and still be at work for 8.  That means I’m only dragging myself out of  bed an hour earlier than normal.  It still stinks.  But, even if I do it once or twice a week that will increase my gym time, which is great for my energy and health and all that stuff.  That also takes back some of my evening for studying or Patrick or other stuff.

I joined a band.  Small groups are starting up again soon.

I finally got a day planner and it is awesome.  Especially for planning ahead for presentations and classes (when they don’t get rescheduled a million times).

Work will stop eating my life.  At least for the most part.  I just need to be proactive about it.  And remember that some weeks work is hungrier than others.  I just need to make life fight back.