Go Rick Mercer

This rant speaks for itself.  Another reason why I'm proud to be Canadian.  (Rick Mercer, that is.  The fact that gay kids (or any kids) are still getting teased and bullied to the point of committing suicide makes me ashamed of some of the people in my country.)

Study Tunes

When I was a second-year undergrad, studying Organic Chemistry and Biochem until I dreamed in carbon-based molecular structures, I listened to the same two CDs over and over again.  The first was Tori Amos's Under the Pink, my first introduction to non-mainstream music and to the whole concept of feminism.  (What can I say?  I was a sheltered science geek who read Scientific American for amusement.  I had no concept of how the world worked all those years ago).  The second was Dave Matthews Band's Crash, which was filled with energizing beats to drive me forward when I couldn't bear the thought of reviewing another biochemical pathway.

I listened to nothing but those two CDs through all of my study sessions for that entire year.  When I hear a song from one of them, even though it's 14 years later, I'm transported back to the dingy basement hallway in which I studied daily with my friends.  We called our study area the wind tunnel, because the pressure in the hallway was lower than in the areas surrounding it, so there would be a gust of wind and a rustling of study papers any time someone opened the door into it.  Our university's maintenance budget had been frozen along with our tuition, so the walls were filled with cracks and water would drip from the ceiling when the snow melted in the spring.  It was a horrible place, but for that year it was more home to me than my parents' house, which I only visited for a few hours of sleep in between the long days of studying.

Having the right study music, for me anyway, is key to getting the most out of my studying.  The music has to be familiar enough to me that I don't get distracted listening to the lyrics, without being boring from having listened to it too many times.  (Although, my story above clearly illustrates that I can listen to an album many, many times without becoming bored with it.)  The tempo and intensity of the music need to be right for my mood - slow and calming for times when the studying is relaxing and effortless, but uptempo and energizing for times when I'm fading and need an external push.  I think that's why the two CDs worked so well for me in second year undergrad.  Tori Amos was my daytime music, carrying me through the easier times when I was still alert, while Dave Matthews Band was my evening music, keeping me from falling asleep and drooling on my diagram of the glycolysis pathway.

What motivated me to write this self-indulgent, backward-gazing post is the fact that I'm feeling a bit stuck for study music.  Currently, I seem to be listening to the same artists over and over again - David Grey, Coldplay, Sarah Harmer, Sam Roberts, Jack Johnson, Matthew Good - and while they're all excellent, I'm longing for an infusion of some fresh blood.  I just added Sarah Slean to the rotation, as I'm going to her concert in a few weeks and feel like I should know at least some of her songs, but it's still not enough.  So my question for you, as I bundle up against the cold and head out to Starbucks for studying and a latte, is what are you listening to while you're studying?

(And if you're one of those smart people who structured your life in such a way that you don't have to study anymore, good for you.  Enjoy lounging on your couch eating bon bons while I tackle the WHO's guidelines for the treatment of tuberculosis.)

Progress - A Quick Friday Night Note

Friday is finally here!  This week has felt really long, what with spending my days running from the ward to consults to clinic to teaching to evening commitments.  I'm also still feeling the effects of my recent night shifts (I'm really slow to adjust this time), so I've been dragging a bit from an energy perspective.  But the weekend is here, and all I need to do is jump the hurdle of one last home call tonight and then my time will be my own again for 48 hours.  It shouldn't be too bad, as the ward is full and most of the patients are fairly stable.

(Dear Universe, please don't view my previous statement as an invitation to make the Respirology ward explode with sick patients or to make eight people with spontaneous pneumothoraces present to the Emergency Room simultaneously.)

So far tonight my only pages have been from Pharmacy asking for help reading orders that I wrote earlier in the day.  Apparently things written with my favourite Bic fine-point blue pens don't always transmit well over the fax machine.  :(  So I am now the proud owner of three boxes of Bic fine-point black pens, which I will use for all future medication orders.  Things are getting wild and crazy over here in Solitary Diner's world.

The hospital was relatively quiet today, so I was able to sneak away from the wards and get in some study time.  It feels like I haven't studied in weeks, and it's actually really nice to get back to it.  The things I see in the hospital make so much more sense and stick so much better in my brain if I have some theoretical knowledge behind them (and vice versa).  One of the things I was reviewing today was the differential of bronchiectasis, and it was satisfying to realize that I've seen almost every item on the differential at some point in my clinical career.  As I was reading, I kept thinking "Oh yeah, Mr. H. on the Respirology ward has allergic bronchopulmonary Aspergillosis" or "Mrs. C. from the Medicine ward last year had hypogammaglobulinemia".  It's definitely much easier to remember things when I can put a face to them.

Thanks to the time in the day today and a relatively quiet evening, I'm on track to complete my study goals for the week.  Currently, my goals look like this:

Week One – October 24-30:

-       Journal Club articles and review questions

-       Harrison’s:

o   Chapter 251            Approach to the Patient with Disease of the Respiratory System

o   Chapter 165            Tuberculosis

o   Chapter 329            Sarcoidosis

o   Chapter 263            Disorders of the Pleura and Mediastinum

-       Chest 2011 COPD Guidelines

And I have tomorrow set aside for mostly studying.  I may study the chapter on bronchiectasis and lung abscesses that was scheduled for next week instead of the COPD guidelines, but otherwise it looks like I'll meet my goals exactly.  Go me!  I have to say that setting goals for this rotation has been a really positive thing.  I've been a bit scattered with my studying so far in residency, and it's left me with the feeling that I'm just learning random facts rather than whole areas of medicine.  It's nice to know that, if I stick to my current study schedule, I'll have covered all of the major areas in Respirology by the end of the rotation. 

So that's the current state of things in my endlessly exciting life.  I'm about to watch some PVRed Grey's Anatomy while waiting for the ward to page me back about a new admission who needs some orders clarified, and then it's off to bed so that I can get an early(ish) start on the day tomorrow.  Less than two chapters of Harrison's to get through tomorrow.  Easy-peasy.  If I finish early enough, I may even take the time to write some of the posts that have been brewing in my head ever since our Women in Medicine evening last night.  I promise they'll be more interesting than my discussions about the type of pens I use.

Not Helping

(Before reading this post, please understand that I love my Mom dearly.  She just drives me utterly crazy at times.  Hence the post.)

My mother phoned tonight.  Phone calls from her always put me slightly on edge, because without warning she can hit me with the full force of her mom guilt (see here for example) or mom judgment.  Tonight was no different.  After a relatively benign conversation about what was going on in our respective lives, she asked me what I'm doing this weekend.  When I said that I would have time to get together with her (yay for a full weekend off!), she commenced with the following:

Mom:  "Oh good!  I think we should use the time together to organize your storage space."

SD (under my breath):  "Wheeeee." 

Mom:  "I can't believe you've been living there for an entire year and you haven't organized your storage space yet.  It's a disaster!"

SD:  "That's why it has a door.  Which I close."

Mom:  "You can't just close the door, Solitary.  A storage space should be organized!  You should've done this by now."

SD:  "I've been kind of busy."

Mom:  "Busy?  What have you been doing that's so important?"

Um, really?  REALLY?  What have I been doing that's more important than cleaning my storage space?  How about my internal medicine residency?  Hmmm?  Important enough for you?

It makes me want to scream!  (Or vent on my blog.)  My Mom legitimately does not understand why I don't find the time to do things like organize my storage space (and hang pictures, and go to the gym, and clip coupons, and any number of other really important things that I'm apparently supposed to be doing.)  And it is the single most difficult thing about my relationship with my Mom.

In case anyone is wondering, here's what my one evening at home for the entire week looked like:

4:30-5:00  Drive from work to grocery store
5:00-5:45  Buy groceries
5:45-6:15  Drive home and unpack groceries
6:15-7:15  Cook and eat supper
7:15-9:00  Study
9:00-9:20  Talk on phone to Mom while unloading/loading dishwasher, tidying apartment, and assembling recycling
9:20-9:45  Finish tidying apartment, take out recycling, unload cat litter from car
9:45-?       Blog and personal time

And this is not an atypical evening for me.  If I had been able to find more time in the evening, it would've gone to studying - not to organizing my storage space.

I hate that most people outside of medicine (or outside of another demanding job/life circumstance) just don't get it.  Before I started medical school, I really didn't get it either.  I didn't understand why my friends in medicine rarely had the time to get together or why they always seemed so tired when they did make time to see me.  I get it now.  Medicine is a take over your life, eat up your time career, particularly when you're in training and trying desperately to cram all 4012 pages of Harrison's Principles of Internal Medicine into your brain.  Unless you're a much more efficient person than I am, it doesn't leave you with time to organize your storage space.

Ahhh.  I feel much better having blurted all of that out onto the internet.  (Thankfully my Mom is completely computer illiterate and so could never find this blog even if she knew it existed.) 

Anyone have any great suggestions on how to help people outside of medicine understand what it's like from the inside?

Best Laid Schemes of Mice and Men

Until it actually started, I was looking forward to my current Respirology rotation.  The service is reputed to be only moderately busy, and we have two residents, so I envisioned leisurely work days with lots of time to mull over my consults and do background reading on my patients.  With work days ending by 5 PM, I anticipated evenings with abundant time for both studying and normal life activities.  So optimistic was I about how laid back this rotation would be that I put together the following rather ambitious study schedule for myself:

Week One – October 23-29:

-       Journal Club articles and review questions

-       Harrison's:

o   Chapter 251            Approach to the Patient with Disease of the Respiratory System

o   Chapter 165            Tuberculosis

o   Chapter 329            Sarcoidosis

o   Chapter 263            Disorders of the Pleura and Mediastinum 

-       2010 Chest Medicine COPD Guidelines

Week Two – October 30-November 6:

-       Harrison’s:

o   Chapter 33            Dyspnea

o   Chapter 34            Cough and Hemoptysis

o   Chapter 35            Hypoxia and Cyanosis

o   Chapter 89            Neoplasms of the Lung 

o   Chapter 258          Bronchiectasis and Lung Abscess

o   Chapter 261          Interstitial Lung Diseases

Week Three – November 7-13:

-       Harrison’s:

o   Chapter 260            Chronic Obstructive Pulmonary Disease

o   Chapter 264            Disorders of Ventilation

o   Chapter 265            Sleep Apnea

Week Four – November 14-16:

-       review previously studied material

-       if time:

o   Harrison’s:

-  Chapter 252            Disturbances of Respiratory Function

-  Chapter 253            Diagnostic Procedures in Respiratory Disease

-  Chapter e34            Atlas of Chest Imaging

I really had great plans for the next three and a half weeks.  Unfortunately, as it always does, reality had something different in mind.  Yesterday, I had only three hours on the ward in which to review and meet my new patients before heading to Sleep Disorders Clinic.  Then today, I again had only three hours between Grand Rounds in the morning and Academic Half Day in the afternoon to see my patients, review a new admission, and see a new consult in the Emergency Room.  (To add to the challenge of the morning, I had to see the consult in the back of the resuscitation area due to lack of beds.  And the patient was getting a CT scan done until 15 minutes before I was scheduled to review the consult with the attending.  Awesome.)

Evenings haven't been much better.  Last night was spent frantically trying to decode a 60-page chapter on statistics*, followed by a late-night run into the hospital to admit a new patient who conveniently arrived at 10 PM.  Tonight was spent at a Journal Club discussing the 60-page chapter on statistics while trying not to fall asleep or suffer a mental breakdown from frustration.  Thursday night is a Women in Medicine evening, and Friday is another night of home call.  So tomorrow night - ahhhh, tomorrow night - is my one night this week with no call or other commitment.  Think I can study three chapters of Harrison's and the 2010 COPD Management Guidelines in one night**?

* I wish I could have downloaded Old MD Girl's statistical knowledge into my brain.  It would've made Cox hazard ratios and propensity scores much easier to understand.

**  My apologies for this ridiculously boring post.  It seemed like something people would be interested in when I started writing it, and now that I've completed it and realized that it really isn't all that interesting I don't feel like wasting the effort by just deleting it.  Here's hoping I will come up with something more interesting to say before people begin a mass exodus away from my blog***.

***  Inasmuch as 37 followers leaving a blog constitutes a "mass exodus".

Excessive Daytime Sleepiness

I started my Respirology rotation today, and as part of the rotation I spent the afternoon in the Sleep Disorders Clinic.  In between patients, the attending took a lot of time to review the pertinent facts of the cases and to teach around them.  Much of the teaching revolved around sleep apnea, as this was the most common condition for which patients were being evaluated.  One of the things he kept emphasizing was that excessive daytime sleepiness, as indicated by falling asleep when the level of stimulation is low (watching tv, reading, driving, etc.), is a characteristic symptom of sleep apnea.

(I will remind you all now that today is only my fourth day since I switched from nights to days, and it usually takes me at least a week to fully transition between the two.)

Mid-afternoon, the attending handed me a patient information sheet to review in his office while he went to run a quick errand.  Between the slightly warm room, the high-back chair, and the low-stimulation information sheet, I didn't stand a chance.  On his return, the attending found me leaning back in the chair, mouth agape, with drool coming out the side of his mouth.

"Oh, I'm sorry," the attending remarked.  "I thought you were a resident who came for a teaching session, not a patient who came for sleep apnea testing.  Perhaps I should hook you up to the polysomnography equipment?"

At which point I demonstrated the ability to blush like only someone of Northern European ancestry can.

Maternal Guilt

Mom:  "I think I'm going to come into the city.  I'm really missing your Dad today, and being around the house is just reminding me of the fact that he's gone.  Do you want to go for lunch?"

Me:  "Well....some friends are picking me up for dim sum in about half an hour."

Mom:  "Oh"  (said in a truly pathos-inspiring tone)  "Okay....supper then?"

Me:  "Well....I told some friends I'd do dinner and a movie with them tonight."

Mom:  "Oh.  Well....I guess I'll just stay here then.  Alone.  And think of your Dad.  Alone."

(Insert sound of my heart exploding from guilt.)

Edited to add:  Being a somewhat resilient person, my Mom thus far today has taken a nap, visited with my aunt, and made plans to take my grandmother for dinner.  Despite me being a horrible, neglectful child, she seems to be doing alright.

Speaking Too Soon

Apparently when I spoke of the wonders of melatonin at helping me make the transition back to days, it was a bit premature.  Last night I took the same two pills as I had the night before, and from about 11 PM until 2 am it looked like it was working.  And then the ceiling gazing began.  And the tossing.  And the repositioning.  And the cursing of the person who scheduled me to work nights right before my licensing exam.  And the moments of sleep that were just long enough to produce bizarre dreams without any meaningful rest.  (Apparently Bruce Willis and I are great friends, and I am the one he turns to when he has to save the world from attacking aliens.)

The only happy beings in my apartment last night were the kittens, who view insomnia as an excuse for cuddles.  I think Callie may have even poked me in the eye once or twice when I dared to drift off to sleep and stop petting her. 

The one good thing is that, if residency has prepared me for anything, it's working while exhausted and at the bare minimum of my mental capacity.  Going into the exam today, I'm trying to think of it as another call shift, in which I have to function at maximum capacity despite feeling like ass.  I've done it before, and I'm sure I can dig deep into my internal reserves and do it again.  (The prospect of shelling out another $1600 if I fail the exam is a big motivator.)  My grandmother's 90th birthday party afterwards may be another matter altogether, and it's entirely possible that I will sneak away from the festivities to nap in my car.  Hopefully with the 100 or so random nieces and nephews and grandchildren and great-grandchildren in attendance my absence won't be missed.

Cats, Exams, and Cooking

It was absolutely wonderful to go to bed while it was dark out last night, and thanks to a large dose of melatonin I actually slept for a good chunk of the night.  Here's hoping the transition back to daytime hours will be easier than it was last time.  The middle of the afternoon was a bit rough today, but Hobbes was quite happy when I inadvertently fell asleep on the couch, as it gave him a warm human to curl up on.

It's odd - I've had Hobbes for seven years now, and he's never sat on my lap before.  He will happily sit beside me or curled up against my legs, but the lap has always been a scary, too close to a human place for him.  (Hobbes was a rescue cat, and he still retains some of the skittishness of a kitten that had to fend for himself.)  This all changed yesterday, when he crawled onto my lap and curled up next to Callie as if it was a perfectly normal, everyday occurrence.  And then again today, I woke from my nap to find him cuddled up in my crotch as if it was the best spot ever.

Sadly, I won't have the option of napping tomorrow afternoon, as I have a delightful licensing exam to partake in.  For a mere $1600, I get to spend 5 1/2 hours of my day off performing a series of clinical scenarios that are mostly irrelevant to my field.  I'm rather annoyed about having to spend the time and money on this exam, given that internal medicine has its own $4000 exam at the beginning of fourth year, but it's mandatory for independent medical practice in my country, so I'm just going to have to suck it up.  And smile for the examiners while I'm doing it.  (Professionalism and demeanor are worth up to half of the exam mark on some stations.)

In other news from today, I was finally awake and not working during grocery store hours, so I replenished my bare cupboards and did some cooking.  Tonight's dinner consisted of mushroom and sausage ragu served with parmesan polenta, both recipes from Cooking Light. 

I added an extra sausage to the dish, which in retrospect was a bad idea, as it made the dish very meaty and not as saucy as I would've liked.  It was reasonably tasty, although I think the same effect could've been achieved by just adding sausage to a high-quality pasta sauce.  Not sure whether I'd bother to make this one again or not.

And that is my life in a nutshell.  I'm sleepy, I have cuddly cats, tomorrow I write an exam, and I made food.  Never ending excitement in this corner of the world!

Why I Should Not Go To The Bulk Food Store When Tired:

Because I will leave with chocolate-covered almonds, ginger, peaches, and pears all while forgetting the dried rosemary that was my initial reason for going to the store.

Why I should not eat sushi when tired:

Because I will carefully collect all of the smushed up pieces of avocado into a pile to eat and not realize that they are, in fact, bits of leftover wasabi until I have put them into my mouth.

Why I should not be allowed out in public when tired:

Because I will start singing along to Kenny Loggin's Footloose while stopped at a red light, complete with flailing head and imaginary microphone.  And then I will discover my program director in the car next to me, bemusedly watching my performance.

All of these great examples of sleep deprivation-induced poor judgment came from my post-night float day today.  The cats tried to spare me this embarrassment by lying on my legs and preventing me from leaving the house, but the lure of bulk chocolate and sushi was too great.

(Note cats looking at me sternly while lying on my legs.  They knew what awaited me if I was foolish enough to venture out into the real world.)

 
On a happier note, this means that night float is now over and I can actually go to sleep while it's dark out.  Or at least lie in bed suffering from incurable insomnia while it's dark out.

Um, thanks?

When it's a slow shift, I like to spend a bit of extra time talking with patients.  Many of the patients that I care for come from circumstances that are quite different from my own, and I usually gain some insight and perspective from having "non-essential" conversations with them.  Elderly patients can be the most rewarding to talk to, as they have vastly more life experience than I do, and they are often lonely enough to appreciate talking to a random medical resident in the middle of the night.

This was how I managed to become engaged in a long, winding conversation with a mildly confused elderly woman in the emergency room a while ago.  We spoke of her deceased husband, her children (some alive, some not), how much things had changed since she was my age.  She repeated herself a number of times, as confused elderly patients often will, but I didn't mind, as she told me over and over again "You'll be a great doctor!"

Eventually, as it often does, the conversation turned to me.  After asking me if I was married ("No, I haven't found anyone worth marrying yet"), she replied that I was wise to hold out for the right person.  And then, to encourage me, she said the following:

"Don't worry dear.  I'm sure the right man will come along in time.  You're so..." (Pausing to thoroughly inspect me from head to toe) "...kind!"

Murphy's Law of Night Float

Night working solo:

• 12 consults
• 2 medical emergencies
• 1 very unstable patient

Night working with co-resident:

• 6 consults
• 0 medical emergencies
• 0 unstable patients

I'm really not complaining about how quiet tonight has been, but I find it funny that the universe seems to be so completely incapable of matching workload with capacity.  Either this is proof of the absence of a divine power, or proof of the presence of a divine power that enjoys messing with me.

Up is Down, Down is Up

I was going to write a post about the ongoing anti-abortion protest that I drive past on my way to work every day, but the moment I started to write it my brain yelled "Noooo.  No more sad posts!" and insisted I post something happy instead.  So here, for your viewing pleasure, are some cute puppies*.

Awwwww.  This is a litter of puggles, the type of dog that is raised by Claire's rival for town council on Modern Family.  I had no idea what they were when I heard them mentioned on this week's show, but I wanted one the moment I googled them and saw how rolly-polly cute they are.  Aren't they adorable?  I can't possibly imagine any problem with bringing one home to my live in my apartment with my two cats.  Heh.

In other news, my brain and body are both completely confused by my new nighttime existence.  They were starting to figure things out during the week, when I was sleeping somewhat regularly from 10 am to 5:30 PM, but the weekend has thrown things off again.  I woke early yesterday at 4 PM so that I could visit my Dad's grave site with my family, and then I stayed up until 1 PM today so that I could have brunch with friends whom I haven't seen in a while.  Add to the fact that I spent my time at home last night in a dimly lit apartment as opposed to a glaringly bright hospital, and my sleep-wake cycles are even more confused.  My Mom phoned me at 7 PM tonight and woke me from a dead sleep, and I hadn't the foggiest idea what day or time it was or what the heck I was supposed to be doing.  That's a great feeling.

I have not yet mastered the art of being productive while being awake at home in the middle of the night.  There's something about it being pitch black outside and knowing that the world around me is sleeping that just doesn't make me want to work.  As a result, most of my night float weekends thus far have been spent in front of the tv catching up on the week's programs.  Tonight, however, I'm determined to do something productive.  My goals for the next 12 hours, which I share with the internets in the hope of being held somewhat accountable to them, are as follows:

1)  Eat "breakfast"**
2)  Actually read the instructions for the licensing exam that I'm taking in six days
3)  Review the current ACLS guidelines for said exam
4)  Review the physical examination of the shoulder and knee
5)  Review sample exam scenarios
6)  Write a study schedule for my upcoming Respirology rotation

Sounds like an excellent plan.  I think someone should come erase Sister Wives and The Amazing Race from my PVR so that I actually have a chance of completing it.

*  If this isn't enough cute puppy for you, check out The Great Balancing Act.  Blogger Susan has recently added a Cavalier King Charles spaniel named Buster to her family, and every time I see a picture I can't resist ooohing and ahhhhing over him. 

**  Speaking of "breakfast", eating is yet another thing about night float that I really haven't figured out.  Do I eat breakfast foods in the evening because it's my wake up time, or in the morning before I go to sleep?  And how the heck do I eat a version of "supper" at 4 am?

Gifts

My Dad was always a horrible person for whom to buy gifts.  I dreaded Father's Day, his birthday, and Christmas because I could never think of a good present to buy him.  When prompted for a wish list, my Dad always came up with the same three items:  socks, underwear, and a snowmobile.  We gave him plenty of the first two over the years, along with an assortment of random items that were offered up in the desperate hope that they would be something he wanted.  He was never one to pretend that he liked a gift when he didn't, rationalizing that it would just lead to us buying more of the unwanted item at the next holiday, so my Dad's gift openings were usually filled with moments of him looking bemusedly at an item and muttering gruffly "Well, it isn't a snowmobile".

Only once did I give my Dad a gift that he truly appreciated.  For my Dad's 50th birthday, my family rented a cottage in a local national park, and I found myself in a small tourist town with no gift (and no access to socks or underwear) on the day of our celebration.  Feeling desperate, I pestered my Dad with questions throughout the day in the hope of coming up with an idea.

"Sooo....what did you think of the plastic totem poles in the gift shop?"
"Do you prefer your pajamas with a cartoon moose or bear on them?"
"How much saltwater taffy do you think you could eat between now and Christmas?"

When my questions were met with only silence from my Dad, I set out despondently to search the local gift shops for a gift that would at least not be humiliatingly bad.  Unfortunately, the stores were filled with $5 drawstring bags of semi-precious stones, locally made dream catchers, and photocopied recipe pamphlets from the Anglican church's women's guild.  I couldn't find anything even remotely appropriate until I stumbled upon a book store and discovered this:

 
Something in the back of my brain said "Dad likes birds", and based on that thought and my growing desperation I bought the book.  When my Dad opened my gift that night, he didn't toss it aside like all of the other gifts that weren't socks or underwear, but instead opened it and slowly flipped through the pages of habitat maps and hand-drawn birds and detailed descriptions of each species and sub-species.  Being a typically quiet man, the only other sign he showed of liking it was looking straight at me and saying, sincerely, "Thank you".

Followed by "But it's still not a snowmobile".

The book proved its worth the very next day, when we discovered an unfamiliar bird outside the cottage that was quickly identified as a pileated woodpecker.  From then on, the book was always in the glove compartment of my Dad's car or in his carry-on suitcase when he traveled.  While on family road trips or weekend drives to the country, my Dad would often pull over to the side of the highway unexpectedly to flip through it, having spotted a bird that he couldn't identify.  My parents' home soon acquired an assortment of bird feeders, and two pairs of binoculars were added to the glove compartment so that my Dad's growing love of birds could be shared with whomever was sitting in the passenger seat.  My Dad was a recorder of information by nature, so he started a detailed "life list" of the birds he saw, first in longhand in an old blue accounting notebook, and then in an Excel file after he discovered the wonder of computers.

Around the time of my Dad's death, giant flocks of birds were passing through our province in a desperate attempt to get to a place that wasn't about to be plunged into sub-arctic temperatures.  The last night that we spent in the hospital with my Dad, I could hear the interminable honking of migrating Canada geese as they made their way south.  As I sat at his bedside, watching my Dad approaching the end, I was filled with this irrational feeling that somehow, once my Dad was gone, he was going to send us a message through the birds.  I didn't want to linger at the hospital after he died, afraid that I would miss it if I didn't get back to my parents' house in time.

Later that day, I was dozing on my parents' couch next to my sister-in-law when the usual chatter of the birds outside intensified.  Through the living room windows, I could see blackbirds in the limbs of my parents' birch and oak trees.  Running outside, I was met by a cacophony of sound from the hundreds (thousands?) of birds that had stopped to rest momentarily on my parents' property.  All told, it probably lasted less than two minutes before the flock was on its way again.

Whenever I think about my Dad's death, I go back to that moment.  I'm a lifelong agnostic/atheist and I have no belief in a spiritual world - and yet.  All I know is that, in the four years that I've been visiting my parents' home in the country, that was the only time I've stood in their forest and been serenaded by a flock of migrating blackbirds.

* * *

Thanks for indulging my reminiscences about my Dad's death these past few days.  In some ways I feel like I still haven't fully processed it, as the past two years have been filled with tasks that have always seemed more pressing than grief.  Being awake and often alone at night thanks to my current rotation invites brooding and reflection, and I'm sure that's where these posts have come from.  It's good for me to remember though, and I hope that you're getting something from these posts as well.  If not, I promise to be bitching about my job again by the time I go back to work Monday evening.

Mental Health in Medicine - A Link

Action Potential has a great post up about dealing with panic disorder as a medical student.  In it, the author* talks about her concerns that seeking treatment would mean that she was unfit to be a physician.  As I mentioned in my recent post, I believe that we need to talk more about mental illness in medicine because it's common in medical professionals of all types, it doesn't prevent someone from being great at their job, and it can get so much better with treatment.

Check out the post.  

*I couldn't figure out the name of the author from the blog.  If anyone knows (or the author happens to read this), let me know and I'll update this post.

Two Years

Two years ago, I was a fourth year medical student doing an elective on the inpatient oncology ward at a local hospital.  My choice of electives was perhaps not the wisest, as in the outside world my Dad was in the process of dying from metastatic melanoma.  Witnessing my personal life reflected in the patients and families around me was a bit like torture, and I would periodically have to sneak away to a bathroom stall or my brother's office to cry.

Two years ago yesterday, at around noon, my pager went off.  My heart raced when I saw my parents' home number on the display followed by "25", the code number I'd told my parents to use in the event of an emergency.  My Mom answered the phone, sounding frantic.

"Solitary, something's wrong with Dad.  He didn't sleep all night, and he's upset, and I can't get him to lie down.  I don't know what's going on.  We've called an ambulance and we're going to the hospital."

I soothed my Mom as best as I could, using the same phrases and calming tone that I'd used on patients and their families over the course of my elective.  I promised my Mom that I'd drive out to the hospital as soon as work was over.  In retrospect I should've left work immediately, but I was only a few months away from residency interviews, and I was afraid of jeopardizing my chances at getting a residency spot by displaying any sign of weakness.  I somehow managed to forget about what was going on that afternoon and to focus on the patients, although I came close to breaking down when a patient of ours who was the same age as my Dad passed away in the ICU.

After work, I drove myself home to feed the cats and then 45 minutes out of the city to the hospital where my Dad had been taken.  It was a beautiful day, Indian Summer, and I rolled my windows down so that I could hear the dry yellow leaves of the elm trees rustling in the breeze.  I remember thinking "This is it", and simultaneously feeling both at peace with the thought and completely incapable of bearing it.

Arriving at the hospital, where I myself had worked a few months earlier, the triage nurse welcomed me and asked if I was working that night.  When I told her that I was there to see my Dad, she let out a surprised and involuntary "Oh!" before composing herself enough to direct me to his room.  By luck, the emergency room doctor who was assessing my Dad was a classmate of my brother's and the same doctor who had admitted my Dad six weeks earlier when he'd fractured his pelvis.  As the doctor reviewed my Dad's medications with me and my Mom, I remember joking that my father wouldn't need his Lipitor any more.

My Dad was dozing when I arrived, so my Mom woke him up, saying "Your daughter's here."  My Dad opened his eyes, focused for a brief moment, and said "Oh, you're here."

And then he was gone.  His body kept going for another twelve hours or so, long enough for the rest of the family to gather and say goodbye, but those were the last words he ever spoke.

* * *

I can't believe that it's been two years.  So much has happened in such a seemingly short period of time.  I've been accepted into residency, graduated from medical school, cared for hundreds of patients, and ushered patients and families through the dying process in the same way that my Dad's team ushered us through.  It's been an amazing time, one that I wish I could've shared with my Dad.  I only hope that he knew before he died that I was going to make it, that his death wouldn't derail me from my studies or stop me from achieving my goals.  I know it caused him tremendous pain before he died to think that such a thing might happen.

* * *

For some odd reason, night float shifts seem to follow themes.  One night it will be heart failure, another pneumonia, yet another liver disease.  Last night, almost as if it were a deliberate act on the part of the universe, the theme was metastatic cancer.  One after the other, the consults came in for patients needing their last admission to hospital.  One after the other, I spoke with patients and families, offering comfort, determining what was needed, ushering them through.  It was a strange comfort to me to see these patients and to remember that, as unfair as it was for the universe to take my Dad away from us two years ago, it wasn't an unfairness that was directed at him or at us.  It's just the way life is.  And in the midst of all the unfairness, at least there are people who will stop in the middle of a busy emergency room, ignore the pager beeping away in the pocket of their white coat, and hold your hand so you feel less alone in your grief.

The Math of Night Float

12.5 hour shift

+ 1 hour post-shift teaching session

+ 30 min drive to/from hospital x 2

+ 8 hours of sleep

22.5 hours

Thus leaving me with 1.5 hours per day to bathe, dress, eat, and otherwise participate in life.  I miss the outside world.  And television.  I'm currently foregoing some of the aforementioned sleep to watch part of Grey's Anatomy and write a very short blog post.

In good news, last night was infinitely better than the previous night.  Steady but manageable work, interesting patients, no crises, a few hours to study for my upcoming licensing exam, and a teaching session from one of my favourite hematologists.  After his one-hour case about a patient with an acquired bleeding disorder, I'm starting to lean towards hematology again.  I may need to flip a coin when picking my fellowship.

In even better news, 24 hours from now it will be the weekend!

The Saving Grace of John Lennon

Last night was one of those (thankfully rare) shit storms of a night.  A night of the pager beeping and the portable phone ringing while I was already tied up on a land line.  A night of hearing "Solitary Diner 25" (25 being my hospital's code for emergency) paged overhead when I couldn't respond to my pager fast enough.  A night of running through hospital corridors, screaming orders into the portable phone, on my way to the latest emergency.  A night of pleading with the universe to keep everyone alive until the arrival of the morning team, but being denied my request more than once.

In the wee hours of the morning, walking head down and bone-weary back to the emergency room in the hope of finishing the admission I'd been trying to complete for five hours, I passed underneath a loudspeaker that for some inexplicable reason plays classic rock during the night.  From it came the sound of John Lennon singing a familiar song from my childhood:

"Whatever gets you through the night 'salright, 'salright
It's your money or life 'salright, 'salright
Don't need a sword to cut through flowers oh no, oh no

Whatever gets you through your life 'salright, 'salright
Do it wrong or do it right 'salright, 'salright
Don't need a watch to waste your time oh no, oh no" 

I got a few strange looks as I stood underneath the loudspeaker, laughing slightly crazily at what seemed to be a direct response from the universe to my struggles of the night.

Creature of the Night

Yesterday I started a series of eight consecutive night shifts.  In my residency program, we do two to six weeks of nights (so-called "night float") in place of doing weeknight call while we're the senior resident on the internal medicine wards.  It is truly a wonderful system when I'm senioring, as it means that I get to be on the ward with my team every day and it makes it much easier to keep on top of what's happening with patients.  It also cuts back on my sleep deprivation, thus giving me the energy to be a good senior and to do some extra teaching with my team members.

When I'm on night float, however, it's a system that sucks monkey poo (as one of my good friends would say).  Thanks to a lifetime of insomnia, I don't deal well with changes to my sleep schedule, and there's no change quite as big as having to completely invert my sleep-wake cycles.  My pineal gland* hasn't the foggiest clue what to do with the change and so squirts out melatonin in a seemingly random pattern, leaving me deliriously tired at 3 am when I'm supposed to be seeing patients and bouncing off the walls at 3 PM when I'm supposed to be sleeping.  It does manage to get itself into a consistent pattern towards the end of my night float rotation - just in time to go back to a normal sleep schedule.  Fun!

Yesterday, being the first day, wasn't actually all that bad.  I got to sleep in as late as I physically could (about 1 PM), which was a lovely post-Thanksgiving dinner treat.  I then got to lounge around the house, catching up on essentials like laundry and dishes and cooking, before heading off to my night shift.  Being fresh from a three-day weekend, the night shift itself wasn't too bad, and I was still vaguely coherent when I was seeing my last patient at 7 am. 

Today, however, I think I have some sense of how a squirrel feels after being run over by a semi-trailer.  I only managed to sleep until 1 PM, after which I spent the next four hours in bed cuddling with kittens and trying to convince them that no, it wasn't time to eat yet.  Just moments before I was supposed to wake up, I fell back into a deep, restful sleep...and then was wrenched out of that beautiful place by the screeching of my alarm clock.  I feel like death.  And I start work in one hour and 17 minutes.  Yay!

But, despite my whining, I'm very thankful for this system.  Being on night float and being the person responsible for all of the internal medicine patients in the hospital is probably one of the best learning experiences of residency.  And it does make the rest of the year much easier.  I just need to survive the next seven shifts without having a complete and utter breakdown.

*The pineal gland is one of the parts of the brain that regulates sleep, and it secretes melatonin at night to promote sleep.  It's regulated by light, which is what makes trying to sleep in the bright daytime so difficult.

Turkey Day!

Today was a great Thanksgiving.  It was much more low-key than most years, with only my Mom and one of my good friends (the Anesthetist) joining me for dinner at my place, but it was actually really nice to have such a small crowd.  It kept everything very relaxed and casual, which is exactly how I like to entertain.

Plus it meant more wine for each of us*.

The celebration started in the late afternoon with wine, cheese, and some mandatory pumpkin spice lattes from Starbucks (It is Thanksgiving after all).  After finishing that slightly odd combination, we moved on to beet salad.  Months ago, I had an amazing beet salad with goat cheese and pistachios at a local French restaurant, and I've been wanting to try making it ever since.  It was very simple to make:  I boiled some beets until soft, peeled and cut them into quarters, and then topped with crumbled goat cheese and toasted pistachios.  For the dressing, I used a slightly modified version of the dressing from this Epicurious recipe.  The major modification was using olive oil in place of the pistachio oil (Where does one buy pistachio oil anyway?), which I think detracted from the flavour a bit, but all in all it was a good first attempt.  I'm looking forward to Christmas when I'll have an excuse to make it again.

For dinner, we broke with Turkey Day tradition by having chicken.  My Mom brought a casserole of four chicken breasts on top of a pouch of dressing (mmmm), which cooked in just over an hour and was much easier to serve than a whole turkey.  All in all, a substitute that I was quite happy with.  Everything else was pretty standard Thanksgiving fare:  potatoes, gravy, sweet potato casserole (courtesy of my friend), and white butter pan buns.  Mmmmm.

After dinner and a bit of cleanup, my Mom headed home early because she has to work in the morning, leaving the Anesthetist and I to sit on the couch playing with the cats and talking.  As happens when medical people get together, the conversation quickly turned to medicine and interesting patient stories and the struggles of residency.  The Anesthetist is going through a difficult time of her own, so it was good to share battle stories and commiserate with each other.  Knowing that my struggles aren't unique to me is what makes it possible for me to push through them.

When the talk got too deep, we lightened the mood with a high-brow film from my PVR.

Kevin Bacon in faded jeans, a repressive bible belt town, and classic 80s music:  what is there not to like?  (Actually, a lot.  I had no appreciation for how cheesy and formulaic the movie was when I watched it for the first time at the age of seven.)

Now that Thanksgiving is over, I'm relaxing with the cats and some internet surfing.  It's been so nice to have this whole weekend off and to feel rested for the first time in weeks.  I suspect it won't last long, given that I start a run of night shifts tomorrow, but I'm enjoying it while it does.  All we can do is enjoy the good times.   

*Lest you think we're lushes, we only opened one bottle of wine.  My fridge is now well-stocked for emergencies.

The Long Dark Tea-Time of the Soul

In an earlier post, I spoke briefly about the depression that I went through after moving home for medical school.  While that was by far the worst, it wasn't the only depressive episode I've been through in my life.  I've experienced at least two other episodes:  the first when I moved out of my parents' house for the first time, and the second when I moved away for graduate school.  I didn't seek any treatment with the first two episodes, which I regret in retrospect after experiencing how helpful treatment was with the third.

I hesitate a bit to talk about this, particularly in a place that's as public as a blog, as it seems shameful to admit to having been depressed.  I worry that, if potential employers were to read this, I'd be less likely to be hired.  Or that if patients were to read this, they'd be less trusting in the care that I provide.  Or that if my brother, who thinks Facebook is too public, were to read this that he would come over immediately to kick my ass.  But I think it's vitally important to talk about because it's such a common thing.  Since starting medical school, I've seen multiple people around me struggle with depression and other mental health issues, some to the point of potentially not being able to complete their training.  By talking about it, my hope is to make people who are dealing with mental illness feel less alone.

One of the most fundamental things that changed for me when I went through my most recent (and hopefully last) depression was my perception of happiness.  Up until then, I'd believed very much that happiness was dependent on one's situation, that certain things needed to be present for a person to be happy.  At the top of that list of things was a romantic relationship, but there were other things like weight and appearance and money on there as well.  It took a conversation with a psychologist for me to realize that my list of supposedly important things wasn't required for happiness.  Years later, I still view that conversation as one of the most significant ones of my life.

As a result of that conversation, I started looking for ways to create happiness in my life, even without the relationship and all the other things I had thought I needed.  I worked harder at building relationships and connecting with the people around me.  I made sure that my life had time in it for pleasure, despite the feeling that I should be spending every waking minute studying.  I put a stop to the endless negative self talk that said that the universe had treated me unfairly and that I'd gotten a bad deal in life.  And it worked.  Although certainly not without difficulties and loss, the last four years have been some of the best of my life.

Which brings me to now, and my reason for writing this post.  Being a resident has been another major change for me, and although the experience has been mostly good, I can feel elements of my much less happy former self starting to reappear.  There are so many reasons for this that I can't even begin to capture them all here.  A big part of it is my Dad being gone.  He was the person most like me in the world, and he was always very attuned to how I was doing.  Any time I struggled or started to think negatively, he had a knack for saying or doing just the right thing to help pull me back.  While I love my Mom dearly and know that she always means well, her knack is often for saying the wrong thing and making things worse.  I wish that I could bring my Dad back for just a few hours here and there so that he could make things better again.

Another part is realizing, really realizing on a gut level, just what I signed up for when I started medicine.  The sacrifice of medicine isn't just for the four years of medical school or for the five years of residency - it's a lifetime of having to put my career and other people before myself.  Even if I pick the most lifestyle-friendly subspecialty, I will have to be on call and have a messed up sleep schedule that leaves me feeling tired.  And while I'm doing this, while I'm digging deep into my reserves to do the best job I possibly can, I'll have to deal with other physicians, and nurses, and patients, and patients' family members who will give me shit for not doing a good enough job.  I love the work I do, I honestly and genuinely do, but it's also very hard.  And that's something that I still grapple with.

Another part is that I've been cutting myself too much slack lately.  I've been feeling sorry for myself because of how much I've been working, so I've "treated" myself far too often to nights in front of the tv, and takeout dinners, and time off from studying.  While I know that there's a place for all of these things in my life, I've given them way more time than I should.  Being lazy all day makes it harder for me to sleep at night (hello again insomnia), which just makes everything worse by making me tired the next day.  Too many takeout dinners make me feel like I'm incapable of taking care of myself and add to my anxiety about the inconceivable pile of debt that I'm accumulating.  Not studying is probably the worst of all, because it leaves me feeling incompetent at my job and feeds into my fear that maybe I'm not actually good enough to be a doctor.  I also have a licensing exam in two weeks, and while it's reputed to be easy, I don't want to bet the ridiculously large exam fee that it's easy enough to pass without studying.

So, some of these are things that I can change and others things that I can't.  First and foremost, I think I need to really acknowledge the mental space I'm in and start working on getting through it.  And I need to get off my butt and start doing some of those things that make my life better, even when I'd rather eat Thai food from a tinfoil container while watching America's Next Top Model.  Happiness is really not as elusive as it may seem.

Edited to add:  I just read a post over at Stumbling Towards Nirvana, and apparently today is the WHO's World Mental Health Day.  Talk about perfect timing!

Thankfulness

Happy Canadian Thanksgiving everyone!  In honour of the holiday (and because I can't sleep after spending my post-call day in bed), I thought I'd write a top ten list of the things for which I'm thankful. 

10)  Photography:

Before going digital, I took about 1-2 rolls of film per year because I was too cheap to pay for development.  All of that changed in 2006, when I purchased my first digital camera (seen below in the hands of my niece) as a reward to myself for completing a large writing contract.

I purchased the camera just before going on a trip to Jasper with Boyfriend #2, and over the course of the trip I took an unprecedented 176 photos.  Thus was born my addiction.

I love photography for many reasons.  It allows me to see the world in a different way, to notice things that might otherwise go unnoticed.  In social situations, it's my way of interacting with others even when I feel socially awkward, and sometimes it just keeps me amused when things get boring.  (Like at weddings.)  And being able to look back at all the things I've done, all the experiences I've had and the people I've shared my life with, is priceless.

9)  Travel:

I've been exceedingly lucky, thanks to circumstances and seemingly never-ending room on my line of credit, to have been able to travel to a lot of amazing places.  Since starting medical school alone, I've traveled across Canada (mostly for residency interviews, but also for fun a few times), Cuba (2008), Italy (2010), and Hawaii (2011).  I love almost everything about travel - the escape from ordinary routines, seeing new landscapes, new foods, exposure to new cultures.  And the many opportunities to take photos!  As I type this, I'm already dreaming of the next trip, which will hopefully be to Mexico in February.  (With my mom.)  I would really, really love to go on a culinary vacation here, but given my mom's desire to lie on a beach and my desire to not accumulate too much more debt we will probably go the much more conventional route of an all-inclusive resort.

As an illustration of why I am so thankful for the travel I've been able to do, here are a few of my favourite photos from Italy.

(In case it isn't obvious, I love sharing photos.  Don't you wish you could come to an old-fashioned slide show at my house?)

8)  Food:

Obviously I'm thankful for the life-sustaining aspect of food, but more than that I'm just a huge fan of really good food.  I watch too much Food Network, I have a giant stack of food magazines in my bathroom, and I almost never pass on an opportunity to try a new restaurant.  I can't wait to have Thanksgiving dinner tomorrow night.  Sweet potato casserole....mmmmm.

(I will probably post pictures of this year's Thanksgiving dinner to the blog.  Aren't you excited?)

7)  My Cats:

As a single person, my place can get lonely, so it's nice to have two kitties to come home to.  They also do a good job of reminding me to take a break from studying every once in a while.  (Photo from my Musculoskeletal and Neurology block, which was without question the most difficult and painful block of medical school.)

6)  My Country:

 
I've talked before about how lucky I am to have been born in Canada, but I've been reminded of this recently as a result of working closely with a resident from Libya.  Hearing stories of the decades of oppression under Gadhafi and of the violence of the recent revolution makes me all the more appreciative of the great cosmic lottery that I won when I was born in Canada. 

5)  My Health:

Working in medicine, I can't help but be appreciative of the fact that I'm the one delivering health care rather than receiving it.  I hope that this will continue for a great many decades.

4)  My Friends:

I've been very lucky to have a few close friends from childhood who've stuck with me up until now.  (If a friendship is strong enough to survive the teenage years, it's probably a friendship for life.)  And then I added a great group of friends to the mix in medical school.  Cumulatively, my friends listen to me whine, study with me, take me out for breaks when I start to lose grip on reality from too much studying, and generally just keep me sane.  I don't think I could do this without them.

And some of them even like to take photos as much as I do.

3)  Medicine:

This is worthy of a post all to itself (something I've been meaning to write for a while).  For now, let me just say that I'm very thankful for getting to do work that is mentally stimulating, for working with great people, and for feeling like what I do makes a difference.  Medicine is everything that my previous job was not, and I'm glad that I finally got up the guts to go down this road. 

(That being said, I still reserve the right to whine about medicine as much as I want.) 

2)  Moving Home for Medical School:

When I was accepted into medical school, I was lucky enough to get to choose between staying in Calgary and coming back to my home province.  Despite having a boyfriend in Calgary to whom I was rather attached at the time, it was a pretty easy decision to come home.  I missed my city, my old friends, my family, and I wanted to be in a city where I had a lot of support while I was immersing myself in study.  I received support in many ways during medical school, the most tangible being that my mom would cook me food and wash my laundry.  No matter how busy things got, at minimum I was fed and clothed.

The decision to come home became all the more significant when we found out that my dad was dying.  I had been in a different city from my dad for seven years before moving home, so getting to spend almost four years with him before he died was indescribably valuable to me.  Not to mention the fact that, as difficult as my dad's illness and death were, they would've been vastly more difficult had I not been in the same city as him. 

1)  My Family:

This is also worthy of it's own post.  Given the late hour and the fact that I'm finally feeling tired enough to go to sleep, I'll just say that I've been very lucky in the family department.

Happy Canadian Thanksgiving to all.  Here's hoping that you all have as easy a time coming up with ten things to be thankful for as I did.

Post-Call Math

When I went to bed at 10 am this morning, I wanted to sleep for about seven hours.  So I set my alarm for 7 PM.  Yep, this is how a brain works after being awake for 28 hours.

Technically, it is a Home-cooked Meal

I've been feeling very run-down for the past week or so, probably due in part to my neglect of my plan to cook two healthy meals per week.  So I thought that today, my first day off in four weeks, would be a good chance to get some groceries and cook something special.

How did I do?

Why My Attendings Think I'm an Idiot

Solitary Diner, interviewing a pregnant diabetic patient in Endocrinology Clinic:

Do you take any prescription medications? - No
Any over-the-counter medications? - No
Any vitamin supplements or natural remedies? - No
Have you ever taken insulin before? - No

Endocrinology attending, talking to the same patient after I told her that the patient does not take any medications:

So we'll start you on maternal vitamins and folic acid to ensure that your baby's nervous system develops properly.

Oh (pulling out bottles of Materna and prescription folic acid from purse), my regular doctor already started me on those.

Well, we're also going to have to start you on insulin because your blood sugar is too high.  We'll have our nurse educator come and teach you how to administer it to yourself.

Oh (pulling out insulin pen and vials of short- and long-acting insulin from purse), I've been on insulin for the last three weeks.  And I've been going to the community diabetes clinic for blood sugar monitoring.

(Inside my head:  Seriously?  SERIOUSLY?)

Why I Sometimes Hate Facebook

It will probably come as no surprise to people reading this that I'm a bit of a Facebook addict.  ("Someone who writes a blog and likes Facebook?  I had no idea such a person existed!)  I enjoy finding out what's going on in other people's lives, and logging on to Facebook makes me feel like I'm connected to the outside world even when I'm spending more time in the hospital than out of it.  But the thing about Facebook that drives me crazy are the cut and paste status updates in which people praise the boyfriend/girlfriend/husband/wife/mother/father/child whom they luv sooooo much.  Case in point is this status update that one of my (distant) Facebook friends posted this morning:

"If you have a wonderful man who helps balance your whole world.  Who isn't perfect, but is perfect for you.  Who works hard and would do anything for you.  Who makes you laugh, and drives you crazy, who is your best friend, and who you want to grow old with.  Who you are thankful for everyday and who you couldn't live without.  Brag about him a little and put this as your status!"

Spelling mistakes and bad grammar aside, I hate posts like these.  To me, these posts are an act of rubbing one's happiness in the face of everyone who isn't similarly happy.  I get that people have good things in their lives and want to share these good things on Facebook, and I have no problem with that.  I don't ever take offense at someone announcing their engagement or wedding or the birth of their child on Facebook, because that's the purpose of a social networking site.  But I hate when someone starts a status update such as this, because it's a way of including only those people who have been lucky enough to achieve a certain form of happiness. 

"Have a great man in your life?  Welcome to our exclusive Facebook status club!"

"No man in your life?  Ooooh....you're not invited.  It doesn't matter what else is making you happy in your life, because you haven't managed to achieve the coveted status of 'attached'.  No special status for you!"

Do the people who post these things (and my apologies if you're one of 'those people' and you take offense at this) not realize that these status updates can be hurtful?  How do they think a single person feels in reading the same mushy status update over and over again in their news feed?  What about a childless person reading a generic status update about how wonderful kids are, or a person who has recently lost a parent reading the same Fathers' Day status update over and over and over? 

Maybe I'm being too sensitive, or maybe my patience is just worn too thin by the desperate need to go to bed without my pager on the nightstand.  But it bothers me that in a society in which we're already inundated with messages about the supremacy of romantic relationships that there is yet one more way for the smug marrieds to make single people feel like crap.

(No offense to the smug marrieds.)

Thoughts on 50/50

(Subtitled:  Even my fun activities are all about medicine.)

As soon as I saw the trailer for 50/50, I knew that I wanted to see the movie.  For anyone not familiar with it, 50/50 stars Joseph Gordon-Levitt as Adam, a man in his late 20s who is diagnosed with a rare type of cancer of the spine (a neurofibrosarcoma schwannoma).  What intrigued me about the movie, based on the trailer and the reviews that I read before going to see it, was that it combined comedy with the inevitable sadness and drama of a movie about cancer.  In my experience with my dad's death from melanoma, there was a lot of black humour mixed into the whole process, and I was curious to see whether 50/50 could bring in some of that humour without going over the top or decaying into silliness.  Particularly given that it co-stars Seth Rogen, who doesn't always act in the classiest or most refined of movies.

Oddly enough, getting someone to see 50/50 with me was a bit of a challenge.  Most of my friends had never heard of the movie when I suggested it, and describing it as a "comedy about cancer" didn't really attract a lot of interest.  Apparently I'm one of the few people who equates "cancer movie" with "fun weekend outing".  Fortunately, I have one friend with a lot of time on her hands, so she was game to tag along with me when I invited her this afternoon.  I think she went mainly for the popcorn.

I'm really glad I saw it.  It definitely had me laughing, occasionally to the point of uncontrollably hacking up the last of the gunk that is still lodged in my lung from my recent illness.  But much more than that, it got me ruminating about life and "big issues" in the way that a really good movie does.  What got me thinking the most was the character of Katie, the inexperienced psychologist assigned to support Adam through his "journey" with cancer.  Her awkward attempts to apply her scholarly learning about cancer to her actual interactions with Adam reminded me so much of my most uncomfortable moments as a doctor.  There have been many times when I've been in that position, across from someone who has just been given unimaginably awful news, and I've had absolutely no idea what to say or do.  I'm sure that I've seemed just as awkward as Katie's character at some of those times - I've certainly felt that awkward.

This is one of the things that makes me wonder if oncology could be a viable career option for me.  I love the science of oncology - the complex interplay of genetics and environment and dumb luck that causes normal cellular mechanisms to go so awry - but I don't know how I would deal with the personal and emotional side of it in the long run.  I think I'm pretty good at helping patients to see the positive in their situations and to not lose hope, but I struggle with what to say in situations in which there isn't any positive or any real hope of survival.  This is something I need to give serious thought to in the next few months.  Oncology is number one on my list at the moment, for a multitude of reasons, but I need to know that I can cope with all aspects of it before I make any commitment.

On a lighter note, I would strongly recommend 50/50 to anyone who is looking for an entertaining but thoughtful movie.  My only caveat is that it may not be a good choice if you're dealing with cancer or death in your life, unless you're looking for a good cry.  Regardless, take tissues.