Two hours ten minutes

Giving birth is one of the most unglamorous things to which anyone can bear witness. A woman is forced to bear down on a group of muscles that force a 6 and a half pound human being through an otherwise deceivingly small orifice. I do not believe the brain can isolate the necessary muscles required to do just that, which is why half the women I've delivered in the last week on obstetrics service defecate on delivery. Again, unglamorous.

It's more or less the same as any other tough rotation I've had (they have, quite honestly, all been tough so far). I don't know as much as I probably should by now, the other residents are likely better than me, I'm not getting any extraneous reading done, and my feet hurt every single day. Significant changes have occurred in the time surrounding the rotation, though. I have been forcing myself to work out after work for the last 3 days. I've been eating well, I even played my guitar last night. Tonight I might do some reading if I manage to quickly arrange my patient data for Wednesday's clinic, so that I have a good idea of who I'm seeing before I see them.

This may all have something to do with me having just had a birthday. It was my birthday on Saturday, and while there was much partying on Friday (honestly it was more tame than I expected, but most people had to work the next day, residents on call and whatnot, and I don't drink), Saturday was spent in personal reflection over the year as a whole, the start of residency, and how I should proceed if I'm to live to see another 73 birthdays (I forgot to mention, the goal is to live to 100).

I may have had some of these thoughts while on vacation. I've noticed I've managed to reign in a lot of my "stress" feeling, and replace it with "yeah, okay, cool" feeling. As in "I don't know, and that's fine, and I'm doing my best" sort of thing. I think it's called positive thinking. It's quite the concept, I'm just starting to wrap my head around it. It doesn't mean I don't care about what happens, it means I try to be more confident that I can roll with changes and acknowledge my shortcomings and deal with them like a man. It's more or less believing in myself, if I had to rephrase it for the fourth time in 6 lines of type.

I seem to be fairly good at racking up deliveries. Thus far I've assisted in the delivery of 6 children. Obstetrics is very different from other services in that patients generally don't have a multitude of chronic problems. If they do, they're handled by the "complicated delivery" group, with whom a lowly family medicine resident like myself doesn't work. Others will have some obstetric issues, but there are only so many of those (and yet I still don't know them all, but I'm not worried about that!) On inpatient family medicine service, most of the patients in the hospital will be 75, 70 , 83, 64 , 58 years old, and will have ruined themselves with poor choices. I came out of the labour room exhausted Friday afternoon, ready to soak my feet in one of those whirlpool foot baths (no I've never done it, it just sounds soothing for some reason) and I made my way to the computer to write my note. Patient name? Baby boy blank. Room? Same room number as the mother. Age? Two hours and ten minutes.

End of vacation

72 hours remain before my obstetrics intern rotation, which is supposedly one of the more difficult rotations I shall have in first year. im glad im getting it over with early, and I suppose I should be glad it came after vacation so that I may be "fresh" for it in a sense. I am, however, not looking forward to having to essentially beast the next 9 months nonstop (and more months in second year following that, assuming my two weeks in second year are more appropriately placed). I spent my vacation at home in Toronto, doing absolutely nothing all stinking day for about ten or so days. nobody was home so almost all time in the evenings was spent with  my parents. I liked this vacation because, as I may have previously commented, im not that big on travelling. having said that, there is a vacationto cuba tentatively planned by one of my friends' brothers for May, and I may be trying to get in on that.

there are a few things on the docket for today. the car is in servIcing right now so im being really good about time management. Then I have to pick up my new lever action orange juicer (bed bath and beyond refunded the old electric squeeze juicer even though it was 90 days post purchase) and then I have to finish cleaning my house and have to buy some groceries because I promised a woman a european brunch after our bike ride on saturday. I've been to Europe and I still am not 100% on what that entails. We may have eaten too much pizza while we were there. Oh yeah, and I have to work out. Bought a new doorway chin up bar because I lost the bolts for the old one. if I dont end up using this one its gonna be a laugh and a half and I may end up returning it. if I do end up using this one...beach body for Cuba? Great abs are made in the kitchen though. I would be more interested to see how long my master plan of chicken and salad lasts. A dutch scientist in the news recently commented that sugar is one of the most dangerous drugs of our time, so im going to see how long I can forego it. I say this while realizing the machine squirted some sort of flavouring into my coffee . No good can come of this. Well, maybe some good.

When they gave me this pen

I'm on vacation at home right now. I'm not a big jetsetter/traveler type, I'm more of a relax and reflect type with my vacations, I like to use spare time to get my mind and my environment in order. Standing in 2 hours worth of line to make a flight on time, getting ripped off on cabs and having to recover quickly from jet lag isn't exactly my idea of relaxation, but for many I can see the appeal because I'm sure it's quite exciting.

In November, I'll be on house medicine again, and will have to decide whether to take off the weekend of my friend's wedding or the weekend of my parents' visiting. Perfect.

While I was on night float, a patient came in with his family. He was an older gentleman, very nice man (a rarity to find kindness and gratitude in the North American patient in this day and age) and he was dying of metastatic prostate cancer. In the last month, he had lost 15-20 pounds, had become more depressed, and had a resurgence of back pain. He had not been taking his pain medication as prescribed because he was "not big on taking medication" apparently. He was somewhat anemic, for which our hem-onc department was going to likely transfuse him in the morning, we were just there to control his pain overnight. As soon as we gave him his regularly scheduled medication his pain was adequately-enough controlled for him to sleep, but that wasn't the reason for which I mentioned him here. My interaction with this patient marked my first advanced directives discussion in my medical career. I went over everything on the hospital advanced directives checklist with him; Intubation, mechanical ventilation, these drugs, those drugs, chest compressions, defibrillations, pacing, placement of lines, surgical intervention, everything. The only things he didn't want were intubation and ventilation.

When I got into residency, I was gifted a black Cross ballpoint pen. It's nice and heavy, and it writes well. It's probably only worth about $45, but for a pen and for me, that's a lot. I always imagined myself signing various different things with this pen; prescriptions for patients when the EMR was down, car and house documents, medical office papers, medical license paperwork to be submitted to some regulatory body, personal cheques for important things or extravagances (which, in my life so far, have been few), etc etc etc. I never once thought, when they gave me this pen, that I'd be lending it to a dying man to sign his end-of-life in-hospital emergency decision checklist. It was a tough conversation. It also had to be done, and as far as I was taught, it is always best done by a physician.