Excited Beyond Belief

About two years ago, my Mom and I decided that we should go someplace warm together.  Normal people would make this decision, spend some time looking at resorts online, and then book a tropical getaway, usually within a few weeks of their first discussion about going someplace warm.  Clearly, my Mom and I aren't normal.  Over the past two years, we've had countless discussions about where we should go, all of which have ended with one or both of us rejecting the location under discussion because it was too expensive (Europe), too dangerous (Mexico), too likely to give us food poisoning (Dominican Republic), too boring (almost any resort), etc. etc.

The frequency and intensity of our discussions have escalated recently, as we decided to go away during my vacation that is just three weeks away (woo-hoo!), and until today we had nothing booked.  In desperation to just DECIDE ON SOMETHING DAMMIT, I almost agreed to spend a week at an isolated all-inclusive resort, which was precisely the type of trip that I didn't want to do.  (I hate lying on the beach.  And I don't particularly like drinking.  So I am clearly not a good resort person.)  Fortunately, in a moment of inspiration, I came up with a solution that would combine my Mom's dream trip (go on a cruise) and my dream trip (being unleashed with my camera in New Orleans) all in one:  go on a cruise that leaves from New Orleans.

(In retrospect, a smarter person would have figured this solution out a lot earlier.)

Thanks to this moment of inspiration, and three painful days spent searching online for cruises and flights and hotels that are both cheap and fabulous*, we now have our vacation planned.  Four nights in New Orleans and seven nights on a cruise.  I'm so excited about going to New Orleans I can hardly contain myself.

I want to go here:

 

This photo of the Garden District is courtesy of TripAdvisor

and here:

 

This photo of the St. Charles Streetcar is courtesy of TripAdvisor

and here:

This photo of New Orleans is courtesy of TripAdvisor

and here:

This photo of the New Orleans School of Cooking is courtesy of TripAdvisor

and here:

This photo of American Photo Safari is courtesy of TripAdvisor

Essentially just about everywhere in New Orleans.  In four days.  Totally doable, right?

*  Anyone who has ever traveled to New Orleans will know that "cheap" and "fabulous" is really not a realistic combination in a New Orleans hotel room, particularly when one is booking only three weeks in advance of their travel date.  Fortunately, I managed to find "not horrendously expensive" and "tolerably shabby" all in one.  An acceptable compromise if it means that I can eat beignets and listen to jazz music and fill up my entire 16 GB memory card with photos.  I am so, so, so excited.

Too Good Not to Share

This is for anyone who grew up in the 80s and loved Ferris Bueller's Day Off as much as I did.  Love this!

I still don't like gas-guzzling SUVs, but it's an awesome commercial.

Good Idea Gone Bad - January Goals Part Two

It's almost February, which seems like the perfect time to be writing about my second goal for the month of January.  Heh.  (For my first goal, see here.)  I've been composing this post in my head for a while now, but I've been putting it off because it seemed like a complicated post with multiple issues to address, and I never quite had the head space to write it.  With only one day left in the month, however, it's kind of become a now or never post.  So here goes.

Before getting to my goal, I need to give a bit of background.  Like many women in our weight-obsessed society, I've spent a good portion of my life dieting.  I can remember dieting as early as grade five, when I filled a school notebook with an elaborate scheme in which I could eat certain foods in exchange for doing certain exercises.  It was an utterly ridiculous diet (I seem to recall having to do 50 situps to get a banana), and it didn't last long at all, but it did mark the beginning of almost two decades of battling with my body.  Ironically, I dieted for about ten years before I was ever actually "overweight" by any medical definition. 

The most "successful" diet I ever went on was about seven or eight years ago, when I went on Weight Watchers.  Thanks to the "points" system and the constant reinforcement I received from people who told me how good I looked, I was able to deprive myself of food long enough to drop below my high school weight.   I felt fabulous about how I looked, but I was otherwise miserable.  I was hungry to varying degrees for literally every minute of every day.  I was obsessed with food, fantasizing about the next meal I would eat or about the next time I would have enough "points" saved to eat half a chocolate bar.  And most importantly of all, I discovered that being thin didn't miraculously make everything else in my life better.  I was still dating a jerk, I still hated my job, and I still lived in a city where I had few friends and absolutely no family.  The wonderful life that all of the diet ads had promised me never materialized.

So I stopped dieting and vowed to never diet again.  As a result, I've regained all of the weight that I lost, but I've settled into a fairly constant and comfortable weight for myself, and I've stopped living a life of deprivation and self-loathing.  The improvement in my mental health has been more than worth the increase in my pant size. 

Unfortunately, "not dieting" for me has often translated into "eating garbage".  And while I'm comfortable with where my weight is from an emotional and psychological perspective, I recognize that the foods that I eat don't always promote good physical health.  So in the interest of not succumbing to one of the many lifestyle-related chronic illnesses, I've been trying to shift my eating away from the garbage and towards healthier choices.  My November goal of meal planning was made in part to help me eat better, and it's definitely reduced the amount of unhealthy fast food and cafeteria meals that I've been eating. 

Enter my second January goal.  I quite innocently decided that I would further improve my eating habits by cutting out a lot of the "extra" things that I eat.  The can of regular Coke I drink at Friday noon rounds, the cookie I buy before academic half day, the chai latte that I get at my favourite coffee shop two or three mornings per week - all of those things that aren't essential components of my diet, or even all that satisfying.  The idea wasn't to cut out things that I really enjoyed (I will always overindulge at Sunday morning dim sum), but rather to cut out things that I wouldn't really miss.  It seemed like an excellent way to improve my eating habits.

And it started out well.  At the beginning of the month, I was cutting out one or two things that I didn't really need every day, and it was relatively easy.  So easy that I started to get cocky and to think "I could cut out more".  And that was the point at which a little switch flipped in my brain, and I went from "cutting back on a few unnecessary things" to "depriving myself of things that bring me joy".  To the point where I would stare at a cookie (or bowl of ice cream or chocolate bar) for five minutes, debating whether I really wanted it, or whether I was going to be "good" and not have it.  It was like I was right back in the middle of my dieting days, and it wasn't a good feeling at all.

So, in the interest of preserving my mental health, I stopped.  I decided that eating a few "extra" treats every week was much better than feeling deprived or judging myself for my lack of willpower and self control.  Clearly, my second January goal was an epic fail from a healthy eating perspective.  But from the perspective of reminding myself of why I should never diet, it was a definite success.

Why I Was Freaked Out

Those of you who were reading my blog last fall may remember how I nearly soiled myself when the Parkbeg, Saskatchewan grain elevator unexpectedly collapsed behind me.  For anyone who wishes they could've experienced my fear personally, I recently discovered a video of the grain elevator being demolished on YouTube.

It doesn't quite capture my complete and utter terror, as the people making the video knew that it was a controlled demolition, unlike me who thought that the giant structure was being brought down by the wind a few short feet behind me.

I still get palpitations watching the video.  I wonder if there are psychiatrists who treat grain elevator collapse-induced PTSD.  I see a whole new niche of psychiatry just waiting to be developed.

Unrealistic Expectations

This weekend is the second weekend in a row that I'm not working - joy!  It's exceedingly rare for me to have two back-to-back weekends off (the last time this happened was in July), so I want to make the most of it.

When I have an isolated weekend off, it's hard to be really productive because I'm so tired from the 12- or 19- or (all that is good in the world-forbid) 26-day stretch that I've just worked.  Saturday is usually spent alternating between sleeping and wandering around my apartment in a stuporous quest for food, while Sunday is spent in a frantic effort to socialize and fit in all the tasks that I don't have time for during the week.  But when I have two weekends off in a row, the second weekend is pure bliss.  I feel like my work week is just barely getting started and - tah dah - suddenly it's the weekend again.  I'm well-rested, in a good mood, and ready to take on the world.

Which is why I'm cheerfully dreaming about all of the things that I can do this weekend:

haircut (done!)
meal plan (done!)
groceries (done!)
go to yoga class (scheduled for 10:45 tomorrow)
get together with friends (scheduled for post-yoga)
cook (pancetta-wrapped pork tenderloin tomorrow and polpette Napoletane on Sunday)
study
send out emails re: electives, research, career planning meetings
write 1-2 additional blog posts

Sounds like a perfectly reasonable set of goals for the 48 hours between now and the time when I need to go to sleep on Sunday night.  Unfortunately, my brain refuses to stop there.  Once I get started on my to do list, it just keeps throwing ideas at me until all of the following (and many more) are added to my list:

organize bedroom closet
organize kitchen cabinets
organize storage space
shop for clothes
back up photos
send photo CDs to friends/family
make potato pizza
read photography book/go on photo-taking expedition
watch movie
finish transferring all music CDs to laptop
visit nieces
visit Grandma in hospital (she had a FOOSH earlier this week but is recovering well)
visit Mom

And on and on and on.  An absolutely impossible list for the time I have available, unless I discover an as-yet-unrealized superpower for multitasking.  I suppose I could get my nieces to search online for clothing for me while my Mom helps me organize my closet and my Grandma makes meatballs in the kitchen.  Hmmm....

Oh yeah...and I also want to just chill and enjoy my weekend.  /facepalm

How Do I Put the Brakes on Life?

Today marks the halfway point in my four-week palliative care rotation, and I wish I could make it go by more slowly.  Despite the discomfort that I spoke about yesterday, I'm thoroughly enjoying my time on the rotation.  A very small part of that is the schedule (9 am to 4:30 PM), but mostly it's the work itself.  I feel like what I'm doing has meaning and importance, something that can be lacking for me in other areas of medicine.  I derive a huge amount of satisfaction from taking someone who is in pain, or nauseated, or confused and making them feel better, particularly when they're nearing the end of life.  And I'm excited by the possibilities for expanding the reach of palliative care and integrating it into oncology at earlier stages.  There's huge potential for good within this field.

I spoke with one of the fellows today about how much I'm enjoying the rotation, and she looked me in the eye and said frankly "Then come back and do a fellowship."  She then paused, staring at me thoughtfully, before saying "Some people don't fit with palliative care.  But others do.  And you just fit."

Huh.  So much for my fears that I'm not any good at this.

So my brain is now buzzing with dreams of the future and career planning and thoughts about what I want my life to look like in the coming decades.  And for the first time in a while, I'm feeling excitement about the future instead of a sense of impending doom as the deadlines for fellowship applications rapidly approach.  My plan right now is to go forward with a focus on both oncology and palliative care (sorry hepatology and hematology), anticipating that my career will involve one or both of these fields.  Looking ahead to the next few years, I can see a number of ways that this could play out:

1)  Do an oncology fellowship (2 years) and then practice full-time as an oncologist.  Any time (electives, research, etc.) spent in palliative care during my training would help me to better treat patients' symptoms and support them as they approach end of life, but I wouldn't make palliative care a major part of my work.

2)  Do an oncology fellowship (2 years) followed by a palliative care fellowship (1 year) and then have a joint oncology-palliative care practice.  There are a number of attendings at my institution who have done this, and they're some of my favourite attendings to work with.  I could see myself becoming one of them.

3)  Finish a general internal medicine residency (1 additional year) followed by a palliative care fellowship (1 year) and then work exclusively in palliative care.  Any time spent in oncology would be useful from the perspective of understanding disease processes and treatments, but I wouldn't practice in oncology.

One of the nice things about these scenarios is that scenarios one and two have the same starting point, so I could begin an oncology fellowship without having made a firm decision about a palliative care fellowship.  If I love oncology and want to do it full-time - great, I can start working a year earlier.  If I still feel drawn to palliative care and want it to be a major part of my practice - great, I can still enroll in a fellowship and make that happen.  I think this is what is called a "win-win" situation.

Over the past weekend, I started doing some of the things that are needed to make this happen.  I arranged a meeting with an oncologist to talk about career paths, I emailed schools about visiting electives and now have an elective tentatively booked for May, and I emailed another oncologist about setting up a research project.  There's still a ton more to do, but at least now I have a plan that I'm excited about. 

If only I could skip right through the next year and a half of things that aren't nearly as exciting...

Things that Internists are Bad At

Mornings on the Internal Medicine ward are always chaotic.  With 8 to 10 patients to care for (or more on a busy service), there is never quite enough time before rounds start at 8:30 to follow up on new test results, review any new notes in the charts, check vital signs, and examine all the patients.  As a result, rotating through Internal Medicine teaches residents to be efficient and to minimize all aspects of patient care that don't contribute directly to the primary outcome of making patients better.  Unfortunately, this can mean minimizing the amount of time spent talking with patients and getting to know and understand them on a personal level.  As much as we want to connect with our patients, we often sacrifice connection in the hope of providing better care to the physical body.

Which is why Palliative Care can be such a foreign concept to an Internal Medicine resident such as myself.  Not the pain and symptom control aspects of it - I'm very comfortable assessing physical symptoms and pulling drugs from my arsenal to treat them - but the psychological, social, and spiritual aspects of it.  I've spent my evening reading various articles on Palliative Care (see here and here), and a recurrent theme throughout is that one must address the non-physical aspects of suffering in order to provide good end-of-life care.  Simple enough in theory, but how on earth do I do this?  How do I, who am constantly being taught to be objective and evidence-based in my approach to medicine, suddenly start grappling with intangibles like spiritual and existential crises?  And in my inexperience in this area, how do I keep from doing or saying something that will just make the situation worse?

I keep running up against this discomfort and lack of familiarity in my encounters with patients.  I feel comfortable, competent, at the beginning of the interview when I'm discussing physical symptoms, but as soon as a patient starts talking about his or her grief or hopelessness or spiritual pain, my brain fills with flashing red lights and a panic alarm screaming "Abort!  Abort!"  It takes all of my emotional reserves to stay rooted to the spot and be present with the patient rather than fleeing with a promise to consult Spiritual Care or someone else who is "good at this kind of thing".  It's foreign to me to feel so out of my element in what I'm doing.

Perhaps some of this stems from my own unresolved grief.  When I'm still lacking closure and comfort about my Dad's death, it seems empty and hollow to offer comfort to others.  The suffering of others is a reminder of my own suffering, my whole family's suffering, and of the magnitude of loss that one can't appreciate until they experience it for themself.  I want to offer promises that everything will be okay, but I know from experience how much time and grieving must pass before it is.  And I know too that things are never quite fully okay, that a person's absence will be forever present.  Knowing this, what on earth do I say to someone who is just beginning to grieve?

Oh The Places You'll Go!

For the past week and a half, I've been immersed in end of life care.  My days have consisted of talking with people about death, adjusting medications to improve symptom control, and one by one removing patients from my list as they pass on to whatever may come next.  It's important work and very much in line with my philosophies about end of life, but it can be difficult on the soul at times.

Spending too much time around death can make one forget that there is still a tremendous amount of living that happens first.  Fortunately, I was reminded of the living part of it yesterday, when I got a phone call from one of my friends who was 35 weeks pregnant.  When I greeted her as "Mom-to-be" she said "Well....not a Mom-to-be anymore."

Five weeks early because he just couldn't wait to get out into the world.  Welcome to life baby boy.  You have no idea how much wonder is in store for you.

Baby It's Cold Outside

Thanks to everyone who commented on my last post about the anonymity (or lack thereof) of my blog.  The response I got was the perfect illustration of why I want to keep my blog public - I love getting feedback and different perspectives from everyone who reads my blog.  (It was also really nice to hear that people would miss my blog if it went away.)  While I could certainly invite everyone who is currently reading to a password-protected blog, it would prevent me from attracting any new readers or from participating in things like Grand Rounds, which I really don't want.  So, barring major pressure from a regulatory agency or my program, the blog is here to stay.

(Insert loud applause.)

I'm really appreciative too of everyone who said that I haven't posted anything "bad" here.  When I first started blogging, I was extremely careful to not post anything that could remotely identify a patient/work situation/friend, but I know I've gotten more lax as my comfort with blogging has increased.  It's nice to know that other people think that what I've been posting is appropriate and not likely to get me into trouble.  Fingers crossed at least.

With that out of the way, back to the present...which is ridiculously cold here in my corner of Canada.  So cold that the two heaters in my apartment are running almost 24-hours a day, the "antifreeze" in my car has frozen, and I have not physically been outside in at least three days.  (Thank goodness for underground parking and the tunnels at work that keep me from losing limbs to frostbite.)  It's too cold to go to the grocery store, so I'm subsisting on the rapidly diminishing supplies in my fridge and freezer.  Thankfully they include some tasty tortilla soup.

I'm off this weekend (woo-hoo!), and I plan to see as few people and spend as little time outside as is humanly possible.  My last few weekends off have been very heavy on the socializing, so I'm looking forward to some quiet time at home to study and start setting up future electives.  I've finally come up with a plan for my future (post to come on that soon), so it's time to start moving forward in that area.  (I may also spend some time lying on my couch in pjs eating baked eggs.  Mmmmm.)

Anyone have any suggestions of warm things to cook this weekend?

Anonymous Blogging

One of my friends is an avid reader of medical blogs and periodically links to blog posts on her Facebook account.  Today she posted a link to a blog post that I had commented on - as Solitary Diner, of course - meaning that if someone follows her link and then happens to read the comments, they could easily link through to my blog.  My blog that is filled with identifying information (age, gender, residency program) and photos (like my easily recognizable cats).  

Even though I've always blogged with the understanding that I might be "found out" someday, I've managed to delude myself into believing that no one I know will ever find my blog.  I like the thought of being anonymous and therefore able to share my thoughts freely and without fear of repercussion.  Seeing how close the "real world" is to my "blog world" is a reminder that I'm really not anonymous and that I need to be very careful about what I do and do not share here.

I'm not sure what this will mean going forward.  I'm really enjoying blogging and getting feedback from everyone, but ultimately I can't put my career or my personal life in jeopardy over blogging.  Maybe this will mean I'll need to password-protect some of my posts, or maybe I'll just have to be even more careful about what I choose to share.

If you're an "anonymous" blogger, how do you decide how much information to share on your blog?

Sunday Afternoon Miscellaney

My head is buzzing with many thoughts, all of which are either not significant enough or developed enough to form a blog post, so I thought I'd do a post of short tidbits to share what's going on in my life at the moment.

Grief:

Thanks to everyone who left a comment on my previous post about still grieving my Dad's death 27 months later.   It was both comforting and disconcerting to read all of your stories about how you're still grieving years after a loss - comforting to know that I'm not alone in my prolonged grief, but disconcerting because I would really like to just stop being sad about my Dad's death.  He was a wonderful man and a huge part of my life, though, so I suppose I just need to accept that I will always feel some degree of sadness about him no longer being here.

I really hope my Mom lives forever, because I'm not sure I can handle doubling this grief.

Palliative Care:

I'm enjoying my rotation so far, but it's very odd to be an Internal Medicine resident working in Palliative Care.  The entire mindset is the opposite of what I'm used to.  In Internal Medicine we have to know every detail about our patients, and we thoroughly investigate every little thing that could or does go wrong with them.  It's very different to care for a palliative patient who has IV fluids running without daily blood work, or to not know the cause of a patient's heart failure, or to have a patient who's short of breath but doesn't get an x-ray or a blood gas.  It's also different to work in a field that is so absolutely and completely patient-centred.  Every treatment decision I make is run by the patient or surrogate decision maker to make sure that it's in line with their treatment goals and what they think will make them feel better, rather than what experience or the literature has taught me will make them feel better.  It's a strange but welcome approach to treating patients, and I feel like I'm growing as a physician from my exposure to it.

Cats on a Diet:

On a lighter note, my cats are too fat.

"Jabba the Cat wants more treats!"

  

So now my cats are on a diet, with the approval of my dear friend The Vet, who provides me with veterinary advice in exchange for me listening to her health concerns and then telling her to go see her actual doctor.  Putting my cats on a diet is about as much fun as it sounds.  For an idea of what my life looks like right now, check out Simon's cat.  Clearly Simon's cat was also on a diet.

Home Call:

Apparently my transfer has arrived on the Palliative Care ward, so it's off to the hospital I go.  Wishing everyone well on this cold and grey Sunday.

Recurrent Grief

Before my Dad died, whenever I would read someone's blog post mourning a loss (partner, family member, unborn child) from years earlier, I would wonder why on earth the author didn't just get over it already.  It seemed to me that grief ought to be limited, with an expiry date after which the mourner could simply move on with his or her life and never again be burdened by sadness about the loss.

And then I experienced the loss of my Dad.  The grief of that experience was so terrible and vast that I couldn't process it all at the time, particularly not when I had my final year of medical school and the residency application process to get through.  So I've been processing it bit by bit, mostly at predictable times like anniversaries of his death and special occasions when it's expected and socially acceptable to remember someone you've lost.  But every once in a while, I'm forced to process it at a completely unexpected and inopportune time.

Enter my current rotation in Palliative Care.  This morning, the first day of the rotation, we had introductory teaching sessions on symptom control, opioid pharmacology, and communication regarding end of life.  During the communication session, as we reviewed different scenarios that we may encounter with palliative patients, I felt as if I had been transported back to the months between my Dad's diagnosis and his death.

"Patients may be afraid of the symptoms that they'll experience as they're dying, such as pain and shortness of breath."

"Family members may have difficulty talking with the patient about death and acknowledging what is going to happen."

"Although you are ultimately responsible for the care of the patient, it's the family and other people around the patient who will be left behind after the death to grieve, and therefore it's important to consider their experience of the death as well."

Almost everything the speaker said brought back a memory, with all of its associated emotion and regret.  I was a bit shocked by the rawness I felt and by the way my breath caught in my throat as I struggled to mask my distress.  I came close to losing it when someone asked a question about the ethics of letting family members believe that brain dead patients could hear them, as I couldn't shake the image of my Mom talking to my Dad long after he'd fallen into a coma.  It was only the distraction of my iPhone and a deliberate tuning out of the discussion that enabled me to stay in the room.

Part of me hates that I respond like this.  I like to think of myself as rational, well-adjusted, pragmatic.  Not as someone who can still break down over her father's death 27 months after the fact.  I like to think that I can still go back to a time in my life when I was untouched by death, when I subconsciously believed that everyone I loved was somehow uniquely immortal in a world of otherwise mortal people.  But I'm not, and I can't.  So anyone reading this will just have to bear with me as I continue to write posts about my Dad's death, even when it's long past the expiry date for my grief.

Revolutionary

Something amazing has been happening over the past four days - I've been waking up feeling not tired. I mean, I've been tired in the always-wish-I-could-get-more-sleep kind of way, but not in the not-certain-I'll-make-it-through-the-day-without-falling-asleep-in-an-inappropriate-place kind of way. It's been absolutely wonderful. And all I had to do was give up my late night channel-surfing/Epicurious-browsing/blog stat-reviewing ways. It's definitely worth it.

Score one for my first January goal. (A post on my not-as-successful second January goal to come on a night when I get home more than two hours before my bedtime.)

January Goals - Part One

As may have been evident from my early Saturday morning post, by the end of last week I was pretty spent.  I was so exhausted, physically and mentally, that I was having a hard time focusing at work, and I was about as grouchy as I ever get.  I went for dinner with some friends on Friday night, and I could barely keep my eyes open through the entire meal, let alone be an active participant in the conversation.

But today...ah, today.  After two days of getting a reasonable amount of sleep, I felt like a completely different person.  Despite arriving at work to find that my resident who had been on Friday-Sunday call had gone home sick, leaving all of her patients still to be seen and cared for, I managed to hold it together well on rounds.  I don't want to think about how I might've responded if the same thing had happened last Friday.

The unfortunate thing is that I'm my own worst enemy when it comes to sleep.  Every evening I start out with good intentions, but then bedtime arrives and I want to read one more blog or watch a few more minutes of tv.  I'm as bad as my nieces, who always want one more book or another glass of water before going to bed.  Inevitably, I find myself pushing my bedtime 15...30...45...60 minutes later, until it's physically impossible to get a good night sleep.

So, my first January goal is going to be to go to bed a full eight hours before I need to get up in the morning.  Not heading to bed or quickly checking my blog or packing a lunch - physically in my pjs, teeth brushed, alarm set, and in my bed.  It will likely mean a bit less commenting on my blog and on other people's blogs, but it'll be worth it if I can be a better rested and higher functioning human being.  We'll see how it goes.

And now, it's one minute past my bedtime, and I still have a lunch to pack, a litter box to clean, teeth to brush, and pjs to change into.  Apparently my goal starts tomorrow.

Middle of the Night Chart Review

Whenever anything on my ward goes wrong, particularly when someone dies unexpectedly, I go through the case over and over again in my mind, searching for the thing that I could've done differently to change the outcome.  Clearly there's value in this from a learning perspective, but there's a fine line between self improvement and torturing oneself with unnecessary guilt.  Look hard enough at any chart, and you'll always find something that could've been done better.

Which is why I'm awake in the wee hours of the morning, despite being exhausted to almost my breaking point, reflecting and self berating and wondering whether I'm competent to do the work that I set out to do.  I try not to do this to myself, try to be forgiving of my own imperfections, but my brain is filled with well-established neural pathways of self doubt and blame that will fire in response to the slightest of stimuli.  So instead of sleep, I come here and try to purge myself of the false belief that if I were only better, smarter, more capable that I could somehow prevent anything bad from happening to one of my patients.  That somehow it's only my weaknesses that prevent me from reassembling the broken people who are entrusted to my care.

Anonymous Doc is Reading My Mind

I have a brand new crop of medical students on my service, which means a lot of hand holding and double checking and explaining seemingly basic things.  My memory tells me that I was far more competent when I first started on the wards, but I'm sure that any number of my senior residents would be happy to correct my memory.

As a result of the last few days with the newbies, I couldn't help but laugh hysterically when I read this post by Anonymous Doc.  It captures the feeling of my day so beautifully.

I'm now off to sleep so that I can deal with tomorrow, which is the last day before the weekend.  Woo-hoo!

The Resolution Post

I can't honestly remember the last time I made a New Year's Resolution.  I used to make them every year, usually of the exercise more/eat less/lose weight variety, but I gave them up years ago after never managing to keep them.  I figured that the world did a good enough job of making me feel like a failure without me helping it by providing an annual itemized list of things at which I would inevitably fail.

Which is why I'm not going to make any New Year's Resolutions this year either.  I've been thinking about it for weeks, planning out the resolutions I could make, and composing blog posts in my head, but it's just not my nature to make New Year's Resolutions any more.  I don't want the beginning of my year to be marked by a frantic and ultimately unsuccessful attempt to suddenly change into a better, thinner, more accomplished version of myself.  I want the beginning of my year to be filled with joy and hope and the possibility of wonderful things happening.  And I don't need resolutions for that.

However....there are some changes that I want to make and some things that I want to accomplish in the upcoming year.  And I think my likelihood of being successful is greatly increased if I at least outline some of the things that I want to do.  So here, instead of a list of resolutions, is a description of the things to which I want to devote my energy in 2012.

Becoming a better doctor:  I've committed myself to medicine because I believe that it's a way of contributing something positive to the world while enjoying myself in the process.  I'm passionate about my career, and I'm not content to just be a mediocre doctor who doesn't get sued.  I want to be great at what I do.  That means hitting the books, consistently and with a plan.  I've done a decent job of this in the past year, but I want to study more and focus on the things that I need to study, rather than just the things I'm interested in.  It also means setting up the study group that I've been thinking about for the past year and a half, but still haven't gotten around to organizing.

Preparing for my future career:  2012 is going to be one of the more important years in my training, as this is the year that I'll pick a field and apply for fellowships.  I need to devote a significant amount of time and mental energy in the very near future to finding a research project, applying to out of province electives, and speaking with people in the field(s) to which I want to apply.  It's a terrifying process for me, as it means that I have to decide between oncology, hepatology, and hematology, and it also means that I have to come to terms with moving to a different province in just 18 months.  But the deadlines are going to come whether I'm ready for them or not, so I want to get ready.

Connecting with friends and family:  These are the people who keep me sane and make life worthwhile, so they're the people with whom I want to spend any extra time I may have.

Taking care of my health:  My health was probably the thing that suffered the most when my Dad was diagnosed with melanoma, as it was easy (and fun!) to eat poorly and stop exercising.  Unfortunately, I'm reminded by the patients I see every day that there are consequences to neglecting one's health, and not taking care of myself makes me feel like crap.  I've made steps towards better health in the past year by doing more cooking, but I still have a long way to go.  In 2012, I want to keep eating better, get back to exercising, and get more sleep.  Much, much more sleep.

Experiencing life deeply:  Looking at what I've written up to here, I already have a lot laid out for 2012, but I don't want the year to be all about work and self-sacrifice and preparing for the future.  I know that I'm not guaranteed anything more than the current moment, and that it's entirely possible (although unlikely) that I won't live to see the end of 2012, so I want to keep living through the process.  I want to travel to new places and experience new things and really be a participant in life.  Even when I'm tired.  Especially when I'm tired.

So that's it.  My list of things that aren't quite resolutions, but that are priorities to help me better focus my energy in the upcoming year.  My thought is that I'll use this list as a source of monthly goals - small challenges to help me move in the right direction - rather than as something against which to measure my failures.  Sounds better than resolutions to me.

Where do you want to put your energy in 2012?

Tired Again

One of the nice things about being a second year internal medicine resident at my university is the call schedule.  Because of our night float system, most of the call that we do is home call, and most of this requires little to no going into the hospital overnight.  (Except for the nightmare of Neurology, which was thankfully only two weeks long.)  We generally only do in-house call once a month, during which we cover the emergency room consults and act as backup to the teams on the wards.  It's a relatively cushy schedule, and I've gotten very used to not doing long, soul-destroying overnight call shifts.

Which is why the two back-to-back overnight calls that I did over Christmas completely kicked my ass.  I had forgotten how difficult it was to be on call for 24 hours and then to start rounding and writing notes on my patients on the second day.  In four days I did almost one and a half weeks of full-time work.  And I now feel completely and utterly horrible.

Which is not me asking for pity.  (Well, maybe just a wee bit.  Especially because I'm so tired that I just typed "pitty".  Like "kitty".)  It's just me explaining why my posts on New Year's resolutions and my January goal will have to wait a while.  Like maybe into February.  For now, I'm going to bed, hopefully to emerge feeling somewhat human tomorrow.

Hope 2012 is treating everyone well so far.

2011 - The Year In Review

New Year's Eve has always been one of my favourite holidays.  Being a completely secular holiday, it feels like one of the few holidays that I can fully participate in as an atheist.  It also has no defined rituals or mandatory family gatherings, so one can celebrate it in whatever way one chooses (for me, usually something low-key with friends).   And I love the idea of reflecting back on the previous year while looking forward to the new one that awaits.   For me, it's a moment for slowing down and contemplating where I am in my life, as well as where I'd like to go.

Unfortunately, medicine is rarely compatible with slowing down and self-reflection, so I've spent the past four days either on-call or recovering post-call instead of enjoying the holiday.  My great New Year's Eve celebration last night did not involve gathering at my friends' house for appetizers and drinks as I would've liked, but rather involved sitting alone in the residents' lounge watching a time-delayed celebration from my nation's capital on tv.  On the upside, the hospital cafeteria put out free food for all of the staff at 1 am, so I got to enjoy a turkey sandwich and oatmeal raisin cookie with another on-call resident in the middle of the night.

Now that my call shifts are behind me (no more in-house call for the next five weeks!), I finally have the chance to put down some of my thoughts on the year that just came to an end.  Looking back at 2011, it's been a relatively low-key year.  There haven't been any major crises (thank all that is good in the world), nor major changes in my training, nor big exciting personal developments.  It's just been a fairly nondescript year in which I've slowly plodded forward on my way to completing my medical training and becoming a fully licensed physician.   Here's the breakdown of the year, as I see it:

Medicine:  Work has, without question, been at the forefront of my life over the past year.  It's been the main focus of my time and energy, often at the expense of the people and the pastimes that I love.  But not without good reason.  I chose this career path deliberately and after a great deal of reflection, so I'm usually happy to make sacrifices and work hard in order to develop as a physician.

Looking back, this has probably been one of my bigger years in terms of my professional development.  At the beginning of 2011, I was still an insecure first-year resident who would be filled with dread as I watched the other house staff head home at the end of the day, leaving me alone and in charge of a ward full of sick patients for my nights on call.  Over the course of the year, I've gotten comfortable not only with managing a ward on my own, but also with managing a team of trainees who count on me for guidance and knowledge.  My stress level, which once was enough to keep me from sleeping or eating with any sort of regularity, is now at a fairly low and manageable baseline level.  (Except during codes, when the tiny voice inside my head still screams "Panic!  PANIC!" while I try my best to appear calm on the outside.)  I actually have moments of confidence in myself, and on the whole feel like I'm capable of developing into a good doctor.  Most of the time.

Friends:  My friendship circle has shrunken a bit since finishing medical school, as old friends have moved away to residency positions in other cities, and local friends have gotten busy in residency programs that are vastly different from my own.  There's been further change amongst my friends in the past year, as one of them has had her first child (a lovely baby boy born back in July) and another has gotten pregnant with her second child (due in February).  The dynamics are completely different with two babies in the mix, and so long leisurely dinners in restaurants have given way to smaller gatherings in people's homes and cooing over the newest addition to the world.  It's been a bit of a challenge to adjust to the new division between "those who have kids" and "those who do not", but we're a close group of friends, so we're finding ways to make it work.  Even if that sometimes means that "those who do not" meet up at the local tapas bar, while "those who have kids" pass out on the couch in their toy-filled homes.

Welcoming my friend's new addition at her baby shower.

Family:  My nieces continue to grow bigger and more mature, yet somehow they still love their Auntie Solitary.  I am never able to spend as much time with them as I want, but thanks to co-workers who are willing to switch calls and caffeine to keep me awake, I've been able to make it to most of the important events in their lives.  It's wonderful to be in the same city as them, and I try to take advantage of their close proximity as much as I can.

Playing Monopoly Junior with the nieces.

My Mom continues to both amuse and annoy me, in equal measure.  This year has been a very difficult one for her, as she's found herself struggling with my Dad's death even more than she did in the first year after he died, but she's plugging along.  She's starting to make plans to move into the city to be closer to family, which I think will be a positive for all concerned.  As long as she doesn't start dropping by at my apartment unannounced.

Personal:  This has been a year of "never enough time" for me.  There is always more that I want to do - reading, taking photography lessons, exercising, eating better - but never enough time to fit it all in.  I suppose it's a good thing to be busy doing things I enjoy, but sometimes I just want a long stretch of uninterrupted and unscheduled time.

Over the past year, I have managed to find the time for two trips, one to Hawaii and the other to Alberta.  The first trip was to a truly incredible place, although I didn't always have the most incredible time, as I didn't travel particularly well with the friend who went with me.  Far too much of the trip was spent in strained silence or (worse) yelling at each other over what to do and when to do it.  Fortunately the friendship survived the trip, and I at least have some great photos as mementos.

 Beautiful waves on Oahu.

The second trip was also to an incredible place, and was one of the most pleasant and needed vacations of my life.  It was a completely unstructured trip, and I enjoyed being able to do whatever I damn well pleased with my days.  I slept a lot, drank a lot of coffee (slowly for once), and took thousands of near-identical mountain pictures.  It was absolutely divine.

Athabasca Falls, just outside of Jasper Townsite.  (Umm...no falls are visible in this picture.)

The other big thing that I managed to do this past year is start cooking again.  Back in November I set a goal for myself to plan my meals every week, and it's led to me doing a lot more cooking and a lot less eating out.  Although sometimes takeout sushi still wins.

And of course, I started blogging!  While my "official launch" was in 2010, this is the first year that I've blogged regularly and actually established a group of loyal readers.  I've really enjoyed getting some of my thoughts and frustrations out into the world, and I've especially enjoyed the great comments that I've received.  Please keep reading and commenting, as I read every comment that I receive, and they definitely influence my thoughts on the world and my interpretation of life.  

In Summary:  All in all, I can't complain about 2011.  It's been busy and tiring and rough at times, but it's also been a year of experience and growth.  I'm thankful to have enough good memories of the year to overshadow any bad.

Wishing you all a very Happy New Year!  Stay tuned for my thoughts on the upcoming year....