Weekend away

After working almost every day since I got my CPSO number I have taken the weekend off to visit friends and family in Calgary.




Bliss.

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Conversations lawyers don't have with their families

Yesterday was our family reunion. I was late because rounds that morning had been particularly exciting.

Using broad strokes, I explained some of what had gone on to make me take 6 hours instead of the usual 1.5.

"and one patient was my own fault - she was an adorable newborn who I just couldn't put down"

My cousin looked at me, horrified. Then she said, "oh crap, when you first said that, I thought you meant like a vet and I couldn't understand why you'd put a cute baby to sleep forever, doctors aren't supposed to do that"


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I'm so lucky

It was recommended by one of our palliative care teachers that we go to the visitation of our patients that pass if we can, send their family a card if we can't. I learned today that I need to copy out the address of the family of the patient I am palliating if I want to send a card - the floor tends to swoop out their chart quite quickly.

Tonight though, I went to the visitation of one of two of my patients who passed this week. It never ceases to amaze me how willing people are to accept me into their most difficult times of life.

This family was a treat to work with - all on the same page, very open about their concerns and their feelings, funny, realistic. They clearly love their mom. There were no arguments about DNR status or any parts of care. They were touchy, huggy, and generally lovely to be around. We were all grateful that their mom went so quickly. No one ever wants someone as funny and sweet as this woman to spend a long time dying.

She made me giggle when I first met her on admission to the hospital. She asked me 5 times in less than half an hour where her cell phone was. It was safely tucked under the stretcher. She had survived a few re-occurrences of her colon cancer, but this one was causing mediastinal widening that was making it very difficult for her to breath. It didn't take long before we realized this would be her last battle.

It seemed like a natural thing for me to go to the funeral home tonight. It's something you do for people you care about. I recognise that I've known this family for less than a month, but we've spent important moments together and I like them. They were very grateful to see me and said that it was a big deal for me to come.

That threw me off.

I always feel like I'm intruding on someone else's space at things like this. All I wanted to do was pass on my condolences and thank them for letting me be a part of their mother's care. They needed to talk though.

I forgot how little the closest family to the deceased gets to talk during visitations. Everyone else wants to share stories and reminisce and generally, I think, make themselves feel like they belong there. I had very little to say except that their Mom made me giggle. It gave the family room to talk about how the death had affected them. Up to this point, our relationship had mostly been me finding out more about Mom, more about the family's relationships with each other and passing on the care plan to the family. We were talking mostly about things in the past and items on our collective to-do list of death. Aside from reminding them to take care of themselves by sleeping, eating fruits and veggies and remembering to drink water, we didn't talk much about the affect of death on the family.

The brother was focused on his Mom's last 10 minutes. In his line of work, he had been witness to many deaths. He was expecting the worse. Up until Mom's last day, he and his sister had not been alone together in the hospital room. It was clear by Mom's laboured breathing that her death was going to be close. The pair decided to stay with Mom, talking about their childhood and letting Mom know they were there. Quietly, peacefully, Mom just stopped breathing. It was the most peaceful death the brother had ever witnessed and it was obviously very important to him. We both teared up.

Sister was blown away by the caring provided by the nurses in the hospital. She felt welcomed and safe there and knew that Mom was being well cared for during her last days. Even when Mom kept forgetting where her cell phone was, one of the nurses would point it out for her. It was important to sister that I pass that onto the nurses. One nurse in particular found some legal documents that had been left in the room by the family. Worried that it might cause the family more grief when they realised it was missing, she drove to the funeral home after her night shift to make sure the family would have the documents in a safe place. This act of compassion, empathy and kindness was overwhelming to sister and to me, and we both cried a little.

Brother in law wanted to thank me in particular. That seemed strange to me. I was just the resident making sure we ordered the best meds and protocols so that Mom would be comfy. Apparently, I also hugged sister when she needed it, touched Mom when I talked to her and generally shut up and listened to what the family needed. He explained his theory about people not communicating as much know as they used to and that he hopes I can mentor other docs to share a bit of myself with patients and their families by putting myself in their shoes. He was also very grateful that we never tried to push our own agenda. At every step we checked in with Mom and her family to find out what would be the best plan for all.

This time, just I cried. It was the nicest compliment I've ever received. And then I had that nagging feeling again, that I was an Impostor among these wonderful people, sapping energy that they should be funnelling into their own grief and healing. That's when father in law thanked me for letting the kids talk, and I felt useful again.

Suddenly I remembered the cell phone. I asked sister where Mom's cell phone was.

She giggled and said it was in her hands in the coffin. Mom will always know where her cell phone is now.

Evidence based medicine

During this block we spend each Wednesday morning going over research studies to find the best practices in Family Medicine and learn how to determine if the study in front of us is worth paying attention to. I've been feeling like I don't know nearly enough about medicine. This course is shaking up everything I already thought I knew.

Gah.




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But I was expecting to see Dr. Preceptor

Quite frequently the patients I'm expected to see want to see my preceptor instead. Despite residents being a part of my preceptor's practice for more than ten years, they are confused when a resident comes into the office.

They are sometimes very upset that I've come into the room. Others are simply confused about what the procedure in this scenario is.

The ones who are upset either can be convinced that hanging with me for ten minutes isn't so bad or they become too frustrated to allow me to chat with them.

Generally, the patients who allow me to care for them are happy to have met me and will happily see me again. It's just a matter of getting my foot in the door. Literally.

So why do patients get dumped on me as a resident rather than getting to see the preceptor?

There can be a few reasons. Most importantly, the patients I get to see are among the best my preceptor has in his practice. They are generally kind and easy to get along with rather than the usual "difficult patient".

Another reason is much more basic. We are sharing time and patients. I go to the next patient on the schedule. Sometimes the lottery of it all means that some patients end up with residents more than they don't.

Once you've seen a resident and built a rapport with them, it may be logical that your next appointment may be with the resident again.

Given how strapped we are for family docs in Canada, we need to be training new doctors all the time. These docs need to learn in a real environment. It would take much longer for patients to be seen if these residents were buddied with their preceptor.


The problem many patients have with seeing residents is that they feel that the older doc is kept out of the loop. This isn't (shouldn't be) the case.

The resident discusses each case with their preceptor and follows the care plan that the preceptor had previously laid out unless there is a discussion about deviating from it.

When a preceptor takes a resident he/she is responsible for everything that resident does in their name. It's in their best interest to keep themselves in the patient's business.

As a rule though, it's worth letting the resident take part in your care. We are fresh from our teaching, knowing everything new and exciting in medicine. We are eager to please.

And many of us are damn cute.

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Night off!

Cocktails on the patio?
Yes please.


Tea light holder from Ikea.

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Overheard in the hospital hallway

Nurse one "what's that on your shirt?"
Nurse two "um, this? That would be butter."
Nurse one "I guess that's what happens when you have popcorn for dinner"


My preceptor volunteered me to take care of his family member yesterday in clinic. I can take that as a good sign right? As long as he doesn't hate the kid...


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Post call

Pre-clinic breakfast in bed. Mmmmmmmm.


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Sitting next to someone with enthusiastically bad rhythm is very amusing

And very fun!


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99 problems

The college of family physicians in Canada has a list of presentations we as residents are expected to become competent in addressing with our patients. There's about one hundred of them.

My preceptor keeps referring to them as my 99 problems.

As you may have guessed, a bitch ain't one.


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Video

Like most family medicine teaching units, ours has video cameras in the examination rooms. There are a few reasons for this. The biggest is that the preceptors can sit in on what their learners are doing without being an obvious intrusion to the encounter. They sit in a separate room watching the video screen and listening then discuss the plan with us post interview. At the end of the encounter they can provide specific feedback on areas of strengths and weaknesses that the learner demonstrated.

The cameras can also record encounters. These can be used for the learner to review their own performance and reflect on their strengths and weaknesses. The recordings in my program are also shared with other residents who can help each other learn from good and bad aspects of the interviews. It's a rough time. You need to trust everyone else in the group reviewing your tape to be kind and helpful.

Yesterday, I had my first watched encounter. I didn't know it was going to happen. It was awkward when I discovered he'd been watching.

Especially as it was easily the least smooth encounter of the day. I didn't know enough about the presenting complaint to have a well organized approach to my interview or my examination.

The awkward part that I had blocked out until today though, was that after I had rolled over to examine the patient I said "I think the real reason I became a doctor was so I could use the rolly chairs."

So glad that was caught by my preceptor. Gah.

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Great days ...

Done work early today so I'm chilling on my patio with a trashy novel. I have a lot of reading to do but that can wait until the weather is less pleasant. I proved beyond a shadow of a doubt that I need to review my MSK, especially the knee. But that's what residency is for right?


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Still waiting on my CPSO number

So more beer and games.


I dropped off the documents the college "lost" and went into the office to get to know our EMR system a bit better.

I'll be going over the academic program tomorrow morning so I have a clue about what to expect while I wait for my number to appear on the web and let me start seeing patients.

I miss patients.


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July 1

For everyone else in my class this is the first day of residency.


For me it's Canada day and a great excuse to sit on the patio with beer and a board game.

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