Sunday, March 25, 2007

And the winner is.......

Many of you have been asking about the match results. It’s not fair to have kept you waiting so long. Here’s what went down:

The weeks leading up to our rank order list deadline were tough. Bobcat and I were trying to decide whether we should rank our individual first choices (which were not in the same city), or take a chance on love and couples match. In the end we decided to compromise and put our relationship first.

Now those of you who’ve known me for a long time are probably shaking your heads a little in disbelief. Tabby choosing to put a relationship ahead of personal interest? It’s true. I have been historically selfish about career-oriented decisions. Honestly, I’ve had to be in order to get shit done. This was the first life-changing decision where I’ve even considered taking someone else’s best interests into account, and I can’t say it was easy. I can, however, say that when the time finally came for us to decide, the thought of being somewhere without my Bobcat was way more distressing than the idea of compromise (which was previously considered an expletive in my personal lexicon).

In the end, we decided to do a couples’ match. I ranked the Ottawa psychiatry northern program first, and Bobcat ranked the Northern Ontario medical school’s family medicine program first. We got our choice, and so the next couple of years will involve a fair bit of moving around. I will probably be in Ottawa for 3-4 months of the year, and we will try and spend the bulk of our time together in North Bay, with a view to possibility settling down there if we both like it. There will also be a brief stint in Sudbury this fall (unfortunately), which we are viewing it as an adventure as well. Apparently, they have sushi up there. My last couple of years will be mostly in Ottawa, and by then Bobcat will be long finished his residency.

So there you have it friends. If you had said to me even a year ago that things would unfold in this way, I would’ve suggested that you undergo a psychiatric evaluation. But now here I am. I won’t deny that this was a tough decision, but I think it was the best decision, and if you don’t take the odd leap of faith in this life, you just don’t move very far ahead.

Thanks to all of the Tabsters out there who made Carms a little more bearable. You know who you are: editors of various works of autobiographical drivel, writers of reference letters, billeters, givers of strategic advice, givers of moral support. You are all great friends. I sincerely hope you will consider either moving to, or purchasing a summer home in North Bay.


Wednesday, March 21, 2007

paediatric surgery

Surgeons are a special breed, even the paediatric ones. These days it is just so hard to get motivated, and the thought of rising at 5:45 to go to a job that I am not overly interested in, and where I don’t get paid, is not all that exciting. In fact, yesterday it was more than I could bear and I decided to play the sick card. It’s not something I do very often at all. I find it invites bad karma. This morning it was even harder to get up, but I knew I had to go to work. So I did. And it sucked. But I guess it’s possible to get through 2 weeks of almost anything. So that’s what I’m gonna do.


Wednesday, March 07, 2007

The Heart of the Matter

I am doing 2 weeks of cardiology right now. It wouldn’t be my first choice of rotation, but I am paired with a classmate that I really like and we are emotionally supporting each other. Today I was extremely glad she was there with me. We had an emotionally exhausting day.

Our team consists of our staff, a first year resident, Bartycat (my classmate) and me. Yesterday our resident was post call, and today he had something else going on. So it was just Barty and me and the cardiologist. We have about 16 or so patients on the average day, and things are pretty busy. On Monday it took us forever to round (like 9-7:00), and so yesterday and today we were trying to be a little more efficient.

Things are not very organized, to say the least. The cardiologist is a nice enough guy, but he is that stereotypical specialist who is super knowledgeable about their field, but has no clue about anything else. Also, his bedside manner leaves a little something to be desired. So, Bartycat and I are always running around like chickens with our heads cut off, trying to get things done, making sure that people’s constipation gets treated, and that elderly people are not being discharged onto the street at a moment’s notice with no ride home. We are essentially the social committee. I can’t speak for Barty, but I’m pretty okay with that for the next 2 weeks.

Well, today something happened that made me so angry I could barely contain myself. I know I have experienced the occasional conflict with my superiors in the past year and a half, but I don’t think I have ever felt as frustrated as I did today. I was barely able to conceal my rage.

It was a situation where I thought a patient’s best interests were not being respected, and the doctor had already made up his mind about how things should go, and he didn’t even have all of the information. He was ready to diagnose someone with metastatic cancer and stop her medical treatment and he didn’t even frickin’ know what the hell he was talking about.

I could not help myself. I spoke up, and when he didn’t listen, I spoke up again, and again. We were basically arguing in front of everyone (that’s how it felt anyway). Finally, he reluctantly agreed that we could go down to the radiology department and review some imaging studies that had been done in the past, and ask the radiologist what they thought. He did it in a super patronizing way, and I felt like punching his face in, but at least I was getting my way.

I remember one time when I was around 15, I was sitting on the stairs at my parents’ house and just started crying uncontrollably for no reason. It was weird, because I really remember thinking that I had no idea why I was crying but that my prevailing emotion was not one of sadness, rather frustration. I swear today I felt the exact same emotion. There was no way I would cry in front of that guy, but trying to reason with a patronizing brick wall is just about worse than beating your own head repeatedly against said wall, especially when the brick wall has the final say.

In the end, the radiologist agreed that there had been no adequate evidence of metastatic cancer on any previous study. It’s a long story, but there was also a nephrologist involved, and she had been privy to the whole exchange. When I phoned her to let her know that the situation had changed, she told me that she had agreed with me during the discussion/argument. It was a professional courtesy that I really appreciated because she did not need to let me know that she thought I was right, but it really made me feel better about sticking my neck out.

I don’t know yet if this patient has metastic cancer or not, but I feel relieved that she will at least have an MRI which can provide some definitive answers before we charge ahead and make decisions that will have major implications for this woman and her family.

My staff decided to spend the balance of the day educating me on quality of life and health resource issues. He probably wants to fail me, and essentially told me that I am a big bleeding heart (which I imagine must be very disconcerting when you are a cardiologist). He tried on about 7 separate occasions to explain to me the concept of medical futility. I resisted the urge to unleash the fury, and fill him in on everything I know about medical futility, health care resources, and end of life issues.

The day was a mental marathon, but as Bartycat pointed out at the end of it all, we probably had a positive impact on someone’s health care, at least I hope so. It just would be nice not to have to fight those battles.

I love pediatrics and primary care so much. A rotation like this one just drives that home.