laughter makes everything so much easier

I keep finding that the docs I work with use humor to diffuse the stresses of our days. It's a relief since it's one of the mechanisms I use most frequently.

We tease couples who have been married for more than 60 years for not listening to each other.

We pretend that we are going to use the largest needle possible to perform a digital block.

We talk about patients who make us nuts in humorous, if dark, ways.

We find reasons to laugh with our terminal patients - their loss of hair, inability to control their farts, whatever joke the patient has made at their own (or our) expense.

Patients use humor defensively as well. It's one of the few ways they are able to speak the same language as their docs.

Rural Medicine is where I belong

I had the absolute best day yesterday. It started off with me being late. Nothing out of the ordinary. And I went to the wrong room. Also not out of the ordinary.

In the wrong room, the nurses prodded me with questions about me and my partner; generally tried to make me feel welcome.

Made it the OB rounds where I was supposed to be which was mildly boring but incredibly educational. I love being able to learn.

Then to the emergency department. It was a busy day - 4 ambulances, lots of walk in patients. We also had 4 admissions. Wackiness.

We've had a patient with inoperable gut cancer that was an "orphan" patient my preceptor picked up. She has been bleeding constantly since admission and suffering from melena and diarrhea. In gynecology, when a fibroid bleeds too much and the woman requires as many transfusions as my cancer patient does, we consider embolizing the arteries feeding the fibroid to kill it. I didn't understand why this hadn't been done yet so I asked my preceptor who told me to ask the specialist who gave me multiple reasons including "because we don't do it". That's fine he's the specialist not me. Through the week I helped the patient with edema, anemia, increasing food intake, decreasing diarrhea and generally feeling like she and her husband were part of the health care plan.

Last night we transferred our patient to a higher care centre. The specialist was on the phone with my preceptor and told him that they planned to try to embolize the tumour, to which my preceptor responded "oh, isn't that what my medical student suggested last week?". I love this preceptor.

The patient's husband went over the plan with me one last time before the transfer. He'd had a horribly stressful week which he had the nasty habit of taking out on me and the staff. He cried and gave me a big hug before leaving and thanked me for helping them through their week.

In the afternoon all doctors were asked to report to the delivery room ASAP. We ran down the hall and entered to find a shoulder dystocia that wasn't going well. Since so many doctors made it to the room, after the baby was out, I stood back and watched the baby resuscitation (which went well). Dad was also quite far against the wall. Mom was freaking out because baby wasn't doing very well yet. I told him, in my very firm, no nonsense voice, that it was his job to hold mom's hand and keep her calm. Which he did. And that was good.

CaRMS is in

For my birthday my partner took me on an all inclusive trip to Cuba. Fantastic.

We left the Sunday before my residency applications were due which was a bit stressful but I felt like I was ready and had no concerns about my app.

The trip was brilliant - warm water, white sand, carefully screened sun and abundant rum.

The day my application was actually due, I logged onto the very slow, very expensive internet at the resort and checked in on my application. I've made it abundantly clear that rural medicine is for me. Imagine my shock to discover that my rural essay had not made it into CaRMS's hands. Horror of horrors. Seriously.

I ended up having to paste my essay into the small spaces available for me on the CaRMS website, sacrificing other aspects of my application to ensure that the program gets my wonderfully crafted essays about how I belong in the country. Gah.

But, in practice for the day that I will be a physician and need to leave bad days at the office, I finished, freaked out for 1/2 an hour, then jumped in the pool to enjoy the last few days of my vacation.

Stressful? Yes. But I think I'd finish my app early and leave the country again. It meant that I wasn't around while the rest of my friends were freaking out and causing me to stress.

Plus, of course, rum. Tasty tasty rum.

there are so many ways to avoid doing my essays for CaRMS

tonight it's silly movies

Touch

We were out this weekend to listen to live music (the best way to spend the weekend in my opinion). I felt somewhat uncomfortable because so many of my partner's friends, and mine, were very touchy. Rubbing my back, my arms, holding my hand while they spoke to me. Even hugging these folks I hadn't seen in months felt strange.

Growing up, my family was not terribly affectionate. It was something I'm proud of cultivating with my younger siblings. We hugged, kissed and snuggled. Now when they talk to me on the phone they say they love me, we hug every time we see each other.

But I'm not that way with other people. My very good friend in the class mentioned that we don't hug because "I didn't think you were a hugger" - however when I recently met her mother, it was the first thing we did after saying hello.

My idea of touch has changed dramatically since entering medical school. There are several kinds of touch as I see it.
1. The "hand shake". Typically done at the beginning of a new experience with a patient.
2. The "my hand is on your shoulder now because I'm using my stethoscope" touch. It's mildly familiar, helps me know when the patient is breathing if there is too much consolidation to hear well and gently reminds the patient to hold still/not speak.
3. The "this is something I have to do clinically touch". Reserved for DREs, breast exams, pelvic exams, genital examinations. It's all business, get in, get out.
4. The "you're having a really bad day" touch. I'm comfortable with this one even though it's bordering on quite familiar. When I am chatting with a patient with some sort of terminal illness or who has been in hospital for a long time, or with whom I am sharing bad news, I automatically rest my hand on their leg or hold their hand. I worry sometimes that this is more paternalistic than it should be. It's not intended to be, it's how I deal with people having a bad day.
5. The "tickle fit". Strictly reserved for kiddos under the age of 3 who are mostly feeling well. I call it developmental observation.

It seems like my comfort level with touch is divided into two categories - family and non-family. Time to split the second group into friends and patients.

CaRMS is rapidly approaching.

While I know I should have no problem explaining why I want to be a family doc in my personal letters I still find myself lost for words. I blame not writing here. So this isn't procrastination it's work. M'eh whatever.

I've been working with docs who help Canadian newcomers and refugees. These patients are teaching me so much.

I'm learning to be patient. Our interviews take at least twice as long since all questions and answers are filtered through an interpreter. My vocabulary often doesn't match either the patient or their interpreter so I need to come up with new ways to describe what most Canadians are easily able to recognize (e.g. weight loss).

I'm learning that some things make language unnecessary. Making faces at children, laughing, smiling and drawing pictures of flowers, friends and homes.  

I'm learning to laugh. Try doing a cranial nerve exam on someone who has no idea what you're doing. Hilarity will ensue I assure you.

I'm learning that my life is brilliant. I've never been shot. My house still stands. I haven't watched while someone I love was beheaded.

Learning daily from my patients will be my favorite part of being a doctor.

oh no, I forgot to pack my lunch

guess I better treat myself to yummy Thai while I'm here in KW

have I mentioned how much I love electives?