Waiting on exam results is painful

"The mountains of madness have many little plateaux of sanity" - Terry Pratchett, The Truth.

Our exam began May 3. We should expect results by mid June. MID JUNE. ARE YOU EFFING KIDDING ME.?????

I swear I'm having more, and scarier, nightmares now that I've written. All I can do is rethink everything I did during those three days. I'll see a patient with chronic renal disease and remember a test that I ALWAYS do but forgot to mention. Or, I'll see someone who reminds me of the fake patients in the SOOs and almost burst out crying. Unreal.

If, as my mommy thinks, I passed, at least this will be the last round of exams.

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Residency blues. Again.

I'm lucky enough to not have lost any colleagues to suicide...yet. In the US, physicians are the profession with the highest rate of suicide. Pamela Wible has described three scenarios that I know have at least flitted past my consciousness. The idea that we are supposed to take on as much responsibility as we do and not be allowed to address our own distress is appalling. We shouldn't be afraid to ask for help for fear of losing malpractice insurance.

I know I've blathered on about the stress associated with residency, but honestly feel that I just can't do it enough justice. The words to describe the emotional roller coaster just don't exist. Instead, I'll give you a list of events that I have experienced, usually many in the same day.

Received lab results back that confirm invasive breast cancer in my neighbour.
Been so overwhelmed at work I haven't cleaned my poor kitty's box in well over a week.
Delivered a beautiful baby girl to a mom and dad who couldn't stop kissing each other or the baby to let me congratulate them.
Delivered a beautiful baby boy to a mom who because of her own brain injury will not be allowed to keep him.
Revive a patient during a code blue and have him go on to living a healthy happy life.
Help a young woman suffering from a painful cancer sleep away her last week of life. And then help her parents cope with their daughter's decision.
Lost track of so many emails and Facebook messages from friends I'm surprised they still answer me when I do send a note.
Been told that I'm an incompetent physician who needs to do at least 6 months of remedial training.
Been told I'm a brilliant physician and that my preceptor is excited to have me as a future colleague.
Had patients hug me for telling them about their cancer, their lack of cancer, that I'm leaving a practice, that their mom just died.
Newborn baby exams. Smelling newborn babies.
Helping moms learn to breast feed when they've given up hope.
Missed my nephews special events for work.
Finding my own worrisome lumps.
Had my vacation time continually denied until I just gave up and have weeks of vacation at the end of each residency year left over.

The ups and downs never end. It can be absolutely exhausting. My blog has provided me with some outlet for what I'm doing. I also have a fabulous partner who is extra supportive and a BFF who is going through the same crap. But even with all of the help, residency is incredibly isolating.

This doesn't make sense to me.

Residency is supposed to be preparing us for practice. We should be learning the coping mechanisms now that will keep us from planning a 03:00 dive off a bridge.

Which I suppose leads to the question, what prevents us from becoming hopeless? How do we keep our light shining when we barely have the energy to wash our hair?

Zakari Tatasuggests monthly counselling sessions for residents to address the extra stress that residency incurs. She also says "The idea is not to find a perfect solution but to openly discuss and accept that physicians are vulnerable. The current culture that presents physicians as always being in control of their psychological health should be discarded."

I know an attempt was made in my med school to encourage self care, but it wasn't given as much attention as the importance of knowing how to write a clinical note or avoiding embarrassing the school. Lip service from the chosen few lovey dovey types that isn't also reflected in regular practice is soon lost.

Next week is resident wellness day at my institute. Events will be held in a city I try to visit and will include a speech and yoga. One day a year doing something I could do at home by watching a Ted talk while stretching.

As with most other behaviours, I argue that we need to learn and be taught by example. After breaking bad news, do a debrief and check in on one another. A preceptor who is willing to admit to difficulty dealing with everything on their plate and going through the options of dealing with said overflowing plate teaches a valuable lesson. We are trained to recognize depression and anxiety in our patients but rarely ask our colleagues about it. I've seen a doc whom all his colleagues stated was burned out but none were willing to talk to him or ask how to help him slow down and recharge. The lesson I learned is that my own mental health doesn't matter in my profession.

That can't be right.



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This is NOT a 2 am consult

I'm always afraid of being wrong and making a stupid mistake in front of colleagues. I think it's fairly common, we all want to be seen as competent care givers. We never want to admit that we don't something but when our patients need us to 'fess up about our lack of knowledge, we will, and call a friend.

Working in a small ER means that rather than having in house specialists I can bounce questions off of in the middle of the night, all my specialists are elsewhere in hospitals where they are expected to be allowed to sleep from 11pm on because they'll be on call all weekend. It takes a lot of guts to call after midnight.

I'm sure you can see where this is going.

I've seen a lot, but I haven't come close to seeing everything. I try to extrapolate from what I do know to what I'm seeing in front of me. Given what I saw the other night, and what I know from other similar structures, I was going to need help. Apparently I should have known better and that I didn't need help.

I still feel like I did the right thing. I had a patient in front of me with unbearable pain. The resources in front of me where not at all helpful, though I could have looked for the procedure on youtube... I called. I got snarked at. I also got the info I needed and my patient left free of pain.

Since this blog is about making me a better a doctor, what would I do differently next time?
1. look in even more basic books than I was, something like Tintanelli's.
2. YouTube the procedure.
3. Start my consult (if I still decide to call) with "I'm not sure this is a 2am consult, but my pt is in quite a bit of pain...".
4. Take a breath and put everything in context. I frequently let my nurses guide my care. I trust them to know what to do and very often, that's a good call. But sometimes, I need to listen to my own brain and cut them out.
5. Work out how I would do what I need to do - get the patient into position, get the equipment I need in position. There's something about going through the steps first that makes a procedure easier to do and less scary as well.

My partner isn't immune

My partner is incredibly supportive. Like ridiculously supportive. To the point that he is also having exam nightmares.

What a good fellow.


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Exam nightmares

Last night, I was senior resident on call in a teaching hospital. I'd never done this before so it was acknowledged that it was a favour.

My consultant was my grade one teacher. I was still anxious about talking on the phone with her. Not knowing I was on call, I was drunk, and had to speak with her. Mrs. Grade One didn't seem to notice but it was mortifying.

There was also a lot of explaining my age and still being a resident. Also explaining that I'm used to emergencies coming in drips and drabs at my wee hospital.

No actual medicine, just feeling fully out of place and not at all ready.

That's what nightmares ate for though right? To show you what your insecurities are so you can analyse them in the cold light of day and kick them to the curb?

Rawr. I've got this.

And the exam nightmares begin

Even in my dreams, I would rather hunt zombies than study for the exam.

Right now I'm regretting not doing the MCCQE part 2, if only because it would have forced me to start studying a heck of a lot sooner. It also wouldn't have been so shocking to me to find out there is a day of OSCEs as well as the day of SOOs.

This is the second time they're running the CCFP exam this way. It was run in the fall, no problems from what I can tell from my friends who wrote. That gives me hope that it won't be the gong show that the first computer based MCAT was.

So, this nightmare was one of those that make you feel totally helpless. The usual high school crap. I have been studying, but for some reason, haven't written any exams for the past two years and even miss the final exams. I'm looking at never being a doctor again, ever. Not only have I not written exams, I seem to have entirely missed several classes and was never able to find the text books. And, for some reason, I've moved back into my parents' home, along with all my siblings. There is no place for me to study and too many chores to get any studying in. Then, out of nowhere, zombie apocalypse. And I'm relieved? WTF.

I've been interested to see how different residents are choosing to study for this exam.

Some are studying at least 12 hours a week. Coming together in groups weekly and preparing their 99 problems to discuss with each other. Others aren't studying at all.

I'm just trying to stay on top of my clinic work, study when and if I get time.

I've stocked up on herbal tea. I've set up 3 study areas in the house. I have a back up cafe I can use plus the clinic when it's shut.

I've got this.

Taking a break

It's been a while since I gave myself permission to just chill out. There have been some intense, busy, yucky stuff going on up in here. But today, for the long weekend, I used the afternoon to colour.

So worth it.

I haven't done this since first year of university. It clears my mind, keeps me focused on something silly.

This will come in handy as I prep for exams. Again.




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Oh. Boy.

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Residency has tough moments

Telling a medical student what they need to do to pass. Encourage them to do what needs to be done, but let them make the decision to not fulfill any real objectives. Watching someone choose to fail at medicine is very hard to do.


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Residency:

When even my dreams are about me being exhausted but no one will let me rest. My dream last night included begging families to take care of their own children so I could sleep, trying to negotiate future tasks for an opportunity to lie down in a quiet place and asking kitty to join me for a snuggle.

What happened to those good old running for my life dreams that at least provided variety in my life?


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'Twas the night before CaRMS Match

And final year medical students all across Canada are stressed, drunk, taking sleeping pills or oblivious.

Though I know that any of the programs I ranked will be fine, I really want my number one spot most. Anything in my top five will be OK. After that though, it's not as pleasant.

I know I can make a home anywhere and I can direct my own learning wherever I am to fulfill my own goals. But, I would really like to be near friends again, and in a comfortable community. I want to feel like I'm putting down roots not getting ready to move on again. I've always been one to live in the now, not assume that "my life will start after medical school" or at some other distant point in time. Life is what I'm living now. It's just time for me to also look to be planning a future. These are big, grown up, "I'm almost 40" thoughts.

And since everyone knows what my top pick is, will I be dealing with overly sympathetic eyes tomorrow if I don't match there? What if I do end up in my 24th spot? How will I tell everyone?

And they are keeping me awake tonight.

something else you won't hear at law school

"Oh ya, I'm excited about match day. I'm so excited I can't sleep. I keep having night mares of matching to programs that don't exist. Last night it was a neurology program but only for Spanish patients. I don't speak Spanish. They told me I'd have to learn it by July 1st. They didn't care I applied to Gen Surg. They just kept quoting the CaRMS binding contract."

rank list

it's in

despite knowing exactly what I wanted to do, still felt like vomiting after hitting submit

It's exam week

I'm disappointed with how little actual school work/learning I've had time to do this year. It's clear that when I have the time to study and stay on top of the work load (eat all those pancakes) I can do very well.

We had a one week course in Emerg/ICU care this semester. I stayed on top of the material and feel like I killed the exam. Yes it's just one week, but that just meant I was able to stay on top of the work. What makes this win extra scary though is that the rest of the class seems to feel that they did not do well on the exam.

The other three courses this semester though, will not go as well. I'm desperately choosing which weeks I will study. Weeks! Not just lectures or parts of lectures I feel are less important, entire weeks!

We had our OSCE last week and despite studying for the past 2 years and feeling pretty prepared for it, I was knocked off my game a couple of times. It was fun but also, as I said to the examiner for the ankle exam, fully humiliating.

Our school has a pass/fail system so that as long as I make my 60%, I'll make it through to clerkship. For the OSCE, we just need 60% of 60% of the stations. But, I don't want to be the doctor that barely made it through med school. I don't want some doc in administrivia hell looking for the last 1/2 % so that no one has to hold my hand through remediation in the summer. I want to do well in clerkship and need to start making studying a priority in my life. Starting.....NOW.

All talk no action?

One of the first 'touchy feely' things we talked about in med school was how to doctor the doctor. That is, how to treat a colleague in need of medical attention.

I've been thinking a bit about that discussion and how applicable it really could be.

There's something terribly abstract about a lot of the discussions we have in our weekly groups. We talk big, things we would do in certain situations, but will we actually act this way?

I spent a large part of the last three weeks in the hospital with my parent who was having heart surgery. This was unexpected and very scary. My family was kept in the dark quite often about what was going on. Doctors would talk to the stoned patient who would then pass on incredibly strange interpretations of what was going to happen next/what had already happened. At one point, the staff had Dad wrapped up and ready to ship to another hospital while my mother and I were worried in the waiting room, oblivious to why the procedure had taken so long and wondering if anyone was going to come and talk to us. Apparently, they weren't.

Patient centred my large white bum.

Losing control of something as simple as how information is passed on to us was incredibly upsetting, especially for me. I had no idea I was such a control freak, but apparently no one else was surprised.

My father is now home and doing well and doesn't remember much of his hospital stay. All the more reason that his medical decisions and information should have been considered with a family member present. I'm glad he's doing well, but confused about how others dealt with the situation.

Apparently my entire family but one is afraid of hospitals and illness. They choose to ignore it and hope for the best. The one exception is overseas - I can't imagine how stressful that can be.

What bothers me about everyone being afraid of hospitals is the assumption that I will just take care of everything. I get that I'm in med school and can handle a bunch more and understand what's going on. I worry that when my parents are old and in need of help that I will be expected to be the one to take care of them. That worries me. A lot.

I was also thrown by classmates' reaction to me while this was going on. I am currently the epitome of depression. It's from being emotionally and physically exhausted and just so far behind in everything that I need to do. I know it will go away, but I really need support now while I deal with it.

One classmate who I consider a friend but wouldn't think of asking for help emailed me her notes to keep me in the loop on days I missed. I was surprised and very very happy that she cared that much and recognized that I needed a hand. A few others in the class have been very supportive. Ones I would and would not have expected. They noticed I was missing and wanted to know if I needed help. So fantastic.

Others that I consider to be friends are completely ignoring me. I guess they're waiting for the non-depressed me to show her face before trying to engage in conversation again.

This makes me worry about 'the person in our class who will develop mental illness during our 4 years here'. Apparently there's one in every class. I hope the person who notices the out of character behaviour is able to help and can act in the idealized way we discuss in our groups.

What Med School is Like

It seems like whenever I get overwhelmed with what is happening at school, someone asks me how school is going. They mean well. I love that they care, I really do, but I have no way of explaining how I'm feeling without sounding like I'm whining.

The blogger "The Rumours were True" compared med school to eating 5 pancakes every day. He has something there, and it's definitely worth a read.

The idea was made into a short film.

Why do we put ourselves through it?

Dr. Unnecessarily Angry Surgeon comes to in to teach at least once a month

I've been able to get to know the entire class. Really. I know everyone's name and at least 2 bits of interesting information about them. Even the ones who never come to class.


OK, too many videos on one page, I'll start actually writing now.

I love school, it's a great experience. What gets to be stressful though is how absolutely impossible it is to do everything I want to. My undergrad style of note keeping went out the window within a few weeks of starting class - there just isn't time and it just keeps coming. There are "interest group" lectures about absolutely everything. It's a great way to learn what I want to do when I'm done school and I want to hit every one, again, can't.

There are a million committees and community interaction groups, councils and academic events that I want to take part in but again, just no time.

Not to mention the weekly (at least) party.

I'm constantly feeling guilty that I'm not getting to everything and doing as much as I possibly can. It's a bizarre thing. I'm getting used to the fact that I can't do everything but I don't like it. You know I'm pouting.

Lots of information, not enough neurons

AHHHHHHHHHHHHHHHHHHH!!!!

Midterm is next Monday, Finals start the week before Christmas. The first final will be fine but the next 3 I haven't begun to prepare for.

I'm still going to do observerships because that's where I feel I learn more about medicine than I ever do in lecture.

My last was with a hospitalist who let me do rounds with his residents. I was taught to do some tests and was included in conversations about the patients' care. I can't believe it's taken me so long to do these!

My next is a psych observership which I'm really looking forward to. I'm not sure if I want to be a psychiatrist - in fact I'm not at all sure I know what I want to be, but it will be great to learn what they do. I think that no matter what practice I end up taking up, there will be a psych component to it. Same as regardless of which practice we choose, we're all going to be geriatritians. As I go through my class material, I try to think about how what I'm learning is different if the patient is old. Should be good practice right?

One of my finals is MSK (musculoskeletal) so I've arranged for my observership before finals to be in the osteoporosis clinic. It'll be like review for the final right??

The more I think about finals, the more I freak out. It's a lot of information for me to have in my head and be able to apply clinically. Clinical application is fun but requires that I really own the material.

Which means I better get back to work and stop watching Bones.