winding down and gearing up

Obviously, I neglected the blog during the throes of my PGY2 year in Family Medicine is winding down with a few weeks of my final rotation remaining - rural/very remote family medicine in Sioux Lookout, ON.   

CFPC Exam results were available online on Friday evening (Yahoo! I was 'Successful'!), which made the program graduation festivities all that much more of a celebration on Saturday!

it's back to work early again in the morning tho, so I'll leave the post at that pour l'instant.

live from the fish hook capital of Canada!

what a claim to fame... Kenora is also the home of 'Husky the Muskie'. Apparently it is the feisty muskies that are responsible for many of those pesky injuries. I've only worked 4 shifts in the ER, and already i've removed as many hooks from various rueful anglers. I'm becoming an expert at the string technique, passed on to an observant MD from native fishermen in New Zealand who've done it that way, albeit without aseptic technique for thousands of years (or so i've heard). It's quite a slick method, that much is sure.

for more info, refer to http://www.ncemi.org/cse/cse1017.htm

I'm in Kenora for a 4-week ER block, to round out my first year of residency.
Yikes! i can't believe it's almost half-finished already! it's remarkable how much has happened in the interim, how much i've learned...

in other news, since my last post life has been quite full and juicy-

- i met my boyfriend at that halloween party - spending time getting to know him may have something to do with the decreased posting frequency thereafter... i came as a super hero and he had a fabulous home-made 'Doc Oc' costume (ie. a super villain) i guess it's inevitable that sparks would fly!

- work wise - after a couple of months of fam med in TBay, i moved on to a busy month of ER at the Regional Health Centre, also in TBay. That was interrupted by a short 'green Christmas' vacation at Glenmount.

In January, i did an international elective in Nigeria - joining my parents and an eclectic interdisciplinary team of 'Friends of Mkar' for a medical mission for 3.5 weeks. It was overwhelming. I'll post more about it sometime, if i can figure out how and what of those experiences to share in this medium... I had some pretty major reverse culture shock upon return. The busy surgery rotation i came back to forced me to shelf a lot of the stuff i was processing, but i did (and still do) take out parts of it to ponder and grapple with and mourn over and marvel at from time to time. A lot of it is still steeping.

Chris and i visited some friends of mine in Toronto for a lovely wedding in February, and had a good time with them despite both being sick with a doubly nasty cold. We also spent a pleasant day with my parents and brother who also happened to be there that weekend.

My surgery rotation consisted of about 5 weeks of Gen Surg and 2 weeks of Ortho, for both of them I worked with fabulous preceptors, so there was tons of good learning and lots of practical skill refinement and some very memorable patients.

In the middle of all that i took a Wilderness Advanced Life Support course, including taking part in a late-night mock disaster wilderness rescue scenario! It was an interesting mix of personalities in the intensive 4-day course - in the end i think i learned almost as much about group dynamics as i did about wilderness medicine.

After surgery and before my obs/gyn rotation, i joined a bunch of my friends from high school for a leisurely week at a resort in the Dominican for another wedding. There's nothing quite like love to get people together, is there?

I do enjoy obstetrics, and as a woman physician obs and gyn issues will inevitably have a significant representation within my practice i'm sure. Many of my experiences and discussions i had with my preceptors and nurses from that rotation will be invaluable in the future.

Next was a week of 'mandatory' academic activities - highlights included Grad for my colleagues in the year ahead, with a great party at some friend's camp afterwards (i had my first dip in the Lake of the season too - not Superior, but chilly enough, thanks!) Then we loaded into a bus and made our way to Marathon for the 'mines & mills - occupational medicine' focus for a few days. it was great to catch up with friends there! I took ACLS the following weekend, and upon successful completion of the written and 'mega code' tests on Sunday afternoon, i loaded up my car and drove for 6 h to get here. My first shift was at 8 the next morning, and it was a busy one!

and now, this post has come full-circle, so you're up to date in broad strokes. i may fill in some of the memorable and poignant details later. or maybe i'll just move on and comment on the hear and now observations and meandering thoughts...

ah, it's good to be home...

so, i've recovered from that previously described zany week, enjoyed the tail end of my rotation in Marathon, returned to TBay, settled back in comfortably at home with Ruth and Mocha, and started my next 8 week fam med stint.

What i'm enjoying most about being back -

1. company and comforts of home - that speaks for itself, really.

2. that darn cat - i did miss his entertaining antics and affectionate ways

3. access to our well-equipped and well-stocked kitchen, and the farmer's market and bulk food store selections for affordable and exciting ingredient options - we're stocked up on interesting grains and spices and nuts and squash and 'Thunder Oak' cheese (about 20 variations of Gouda - who would've thought?). Today we supped on a fabulous curry concoction from 'The Enchanted Broccolli Forest' - appreciating a delicious use for the old potatoes in the cupboard and a bunch of slightly freezer-burnt peas. Spices are like good accessories, turning an assortment of otherwise boring basics into a meal with panache for the palate.

4. more fun social opportunities! last night i went to a costume party as 'Nelvana of the Northen Lights' (i didn't make that up... google her!). I had a good time, met some interesting people and enjoyed catching up with some of the 'ultimate' crowd who i hadn't seen since the summer.
'Nelvana' (me) 'Ghost of Steve Irwin' (Andrew) 'Cabbage Patch Doll' (Sarah) 'the Sea' (Lisa) Unfortunately my superhero sidekick was on call for internal medicine, so the Superman suit is awaiting its rightful call into action soon - Ruth and i are having a soup supper and costume party on Tuesday...

tension headaches and other frustrations

it's not that bad, really... no, actually, IT IS! it's just frustrating b/c i'm feeling frazzled b/c call (although good shifts for learning and some fun patients) has been busy and challenging enough to disrupt my sleeping patterns and i have a lot of projects and presentations that are 'due' in the next couple of weeks which are consuming my 'at home' time and therefore i'm not getting enough active outside time and i'm getting stir-crazy!

these are the goings-on since i returned to Marathon:

Wed- basically a waste of a day with videoconferenced academic sessions fraught with technical glitches. The morning presentation was mostly inaudible and what i could hear wasn't anything new or particularly valuable - ironically the presentation about communication was poorly communicated... I'm sure the woman is better at the patients bedside than she is at teaching a large group including 4 videoconferenced sites (one of which was me) - at least i sure hope so!
I wrote AK a long letter tho, so it wasn't all for naught... too bad it took me almost a week to actually get it into the mail... that night i picked up some groceries, fixed a simple supper and then worked on my critical appraisal session preparations until late, frustrated by difficulty finding and then accessing the necessary resources. gr.

Thurs - full long day in the clinic, mostly interesting patients and some good learning, still tiring by the end! when i finished up, i went to Kris & Christine's for the evening, and appreciated a fun low-key evening hanging out with Christine and baby Maggie, and with Kris when he got home from work. I worked for awhile on my chart audit project before bed that night, and it was fairly late again before i realized it.

Fri - on call - busy day between the clinic and a few patients in emerg, with a couple of particularly challenging/frustrating cases that took a toll on my energy level. i appreciated a couple of hours 'off' in the evening and worked on my critical appraisal stuff again, then had just gotten into bed at 11:30 when i was called in about a couple of patients, one of whom i admitted, so it was around 2 when i got home to bed again.

Sat - handover took a couple of hours in the am, and when i got home i had a shower and read for a little while before working on critical appraisal stuff again.

In the afternoon, I finally got out for some fresh air and sunshine - joining K&C and Maggie for a hike - we went to Sturdy Cove, which was a pleasant, easy walk (although the path featured many HUGE puddles that added an element of adventure as we plotted out alternate routes around them). We saw a bunch of grouse along the way (not the brightest birds, we were within a couple of feet of them before then scuttled off the path into the bush), and quite a few fresh bear tracks down near the water (not to worry, we were jingling all the way with the bear bell to announce our presence). The cove is a lovely destination, and it was fun to muse with K&C about where they would put a house, windmill, etc. if it was their patch of homeland. On the way back to town, we stopped in at a shop that sells wood pellet stoves, as K&C are considering options to improve the efficiency of heating their new home, which at present just has electric baseboard heating. The place also sells all manner of 'gifts' (mostly over-priced kitsch - well, not my style, anyway), and was a bit too much after just a couple of minutes! It reminded me a bit of hearing Michele describe the flower shop in Iqaluit (which i managed to avoid during my stint up there) that the nurses there used to rave about, mostly b/c it was one of so few available 'shopping options' in town.

The evening was stretched and consumed by working on the critical appraisal stuff, and i'm really frustrated b/c i can't make heads or tails of the statistical analyses the authors use in the results section, which makes it pretty hard for me to evaluate the results and apply the tools i know to determine the relative risk reductions, event rates, etc and the strength of the confidence intervals. it's more challenging b/c although it is definitely a 'therapy' study (my assigned topic) i happened to choose an article that uses methodology and end-points for which the usual RRR,CER,EER, etc aren't readily applicable - and i don't have my stats texts to help me make sense of them. other than this 'critical' aspect, i am prepared for the session, and i think it'll generate some good discussion. i emailed the tutor and a librarian asking for some assistance with resources i can access online, so hopefully they'll get back to me soon!
I couldn't sleep very well that night, and when i finally did, the morning arrived far too quickly!

Sunday i was on call again - starting with heaps of inpatient rounds at 9:30 and then a few ER patients, i had a couple of hours off in the late afternoon which i used for a short nap, and then made muffins and cut up a veggie salad and a fruit salad for supper and meals today. I was called back for a couple of ER patients, and enjoyed using my sewing skills for a chin laceration. Details for a few inpatients kept me there longer, but i was home at around 11:30 to read for a bit, and sleep. the Lord knows as well as i that i really missed a day of Sabbath rest!

Today was supposed to by my 'day off' - but following up on issues from on call yesterday (x-rays and a discharge) took awhile this morning. My chart audit presentation is this Wednesday (as i found out last Thursday night). The required charts for my chart audit project are finally available (there weren't enough initially, so i had to expand the parameters of my search and it took awhile to get them pulled), as many of them as there will be for this project, anyway - so i then spent the whole rest of the day doing my chart audit project (with not much time to spare, i'll be giving my presentation by videoconference).

I've also basically been tethered to a telephone line, b/c i have been waiting ALL DAY for a specialist in TBay to call me back to discuss an important but not urgently life-threatening situation with one of the patients i say on call over the w/e. They requested a call-back number where i could be reached at his convenience, and i made a bit of a nuisance of myself calling back 3 times over the course of the day when i had to relocate for various reasons - hopefully i don't end up with him as a preceptor at some point! Welcome to the tribulations of being a 'periphery doc'. Hopefully i'll have better luck in getting some advice from the one who takes over for him tomorrow morning.

I've had a headache all day, and i know i'm well-hydrated and have kicked my vacation-associated caffeine habit, so i think this one is from a combo of fatigue and stress. Getting the chart audit research and presentation completed takes a load off tho, and i shall soon make my way to bed to help combat the other factor!

Tomorrow morning i'll be at the clinic, and have my final evaluation for this rotation in the early afternoon. I expect that finishing up all of my paperwork there will fill the rest of the afternoon, but then i'm having dinner with Barb & Ray and Pete & Laurie and their adorable combined collection of an infant and two toddlers. fun times ahead there, no doubt!

captured moments from the w/e at Glenmount

Down by the bay, Colpoys Bay...

Evidently, Collyer thought that
blueberries, maple syrup and buckwheat pancakes were a
great way to start the day
there weren't many apples, but it was a lovely day for rambling in the meadows
Sawyer went up after the higher crop
team effort to prepare and press the apples into cider,
sadly, most of it ended up watering and fertilizing the lawn
but what we did get to taste was delicious!
yikes!
Carrie decided a haircut was desperately needed
She let Dawn and i go at it with the scissors...
work - in - progress
um, well, some of it is shorter, anyway!

stuffing

noun - 1) savoury concoction of cubed day-old bread, onion, peppers, raisins, apples and seasonings and turkey juices, baked either inside or alongside the bird and served as an accompaniment, often on such a festive occasion as Thanksgiving dinner 2) fluffy substance, either natural or synthetic, used to fill pillows, blankets, sleeping bags, jackets, etc either as insulation or cushioning.

verb - 'to stuff': the act of adding more of a particular substance than that usually contained by a particular vessel.

eg.

Glenmount for Thanksgiving weekend was stuffed with 13 people, increasing to 21 at the table for dinner saturday evening. Present were Mom, Dad, Me, Jack, Carrie, Dawn & Edward, Sawyer, Collyer, Brian & Laura, Leah, and Sanjay. This was Sanjay’s inaugural visit, he is a friend from Jack’s program, (recently arrived in Canada to continue his studies), but we expect to see him here again, hopefully with his wife the next time. We were joined at various points throughout the w/e by Jim & Val, Fred, Hazel, Jordan, Kent, Carolyn, Mark & Tanya and Heidi.

All occupants were stuffed with nutritious and delicious meals including familiar favourites such as spinach salad with maple-pear dressing and toasted pecans, mushroom pie, homemade swedish rye bread (limpa), turkey, stuffing and cranberry salad with a symphony of sumptuous garden-fresh vegetables, honey pumpkin pie, dutch apple pie... We also tried out some new ones, which are destined to please our palates again in the future - these included curried pumpkin soup, figgy apples, and a pumpkin cheesecake with bourbon-laced whipping cream.

The days were packed with recreation and fellowship - hiking and picking apples (there were not many readily accessible so we used some creative harvesting tactics, and they were small - a low year for wild apple yields, it seems - good thing Carrie picked up a couple of bags from the Meaford orchards on her way home) at mountain lake (where there is no mountain and a very small, shallow lake, but lots of lovely meadowland and a riot of seasonally coloured mixed forest in which to tromp around), pressing apples into cider in the backyard (5 gallons of which poured out of the bucket onto the grass in a tragic turn of events when someone stood up suddenly and the table top shifted into its other ‘bench-like’ configuration as the weight distribution changed - that was a sad, sad state of affairs), walking down by the bay at sunrise, visiting a local potter’s shop in the successful search for a thank-you gift, running old familiar routes nearby, playing in the yard and gardens, worshiping at church, enjoying scenic backroads on the drive home, hiking and spelunking at Bruce’s Caves, taking turns to talk with Jody on the phone, reading, napping, and engaging in activities related to the preparation, sharing, and cleaning up after meals lingered over and enjoyed.

All in all, the weekend and the house and the inhabitants were all stuffed to the point of being pleasantly filled without being crammed, and I am so grateful for this time together with family, and with friends who feel like family. The abundant blessings are gracious gifts from God, meant to be enjoyed and shared, and with gratitude, we endeavour to do so day by day.

for the beauty...

puffball bounty
mom amidst the milkweed and pines
milkweed pod liberation
dancing fluff