Beautiful Canada Geese

As we were driving from a friend’s house this evening, we came across this beautiful sight a few minutes from our home. Beautiful Canada Geese singing in chorus on a lake, likely taking a break from their southward migration for the winter. I couldn’t help stopping to take it all in!

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Canada Geese, Quebec
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Beautiful Fall

Fall is without a doubt my favorite season. The scorching heat and humidity of summer starts to taper off, the mornings become cool and refreshing and the colors of the leaves turn into a breathtaking array of stunning beauty. I never cease to be amazed year after year!

Featured Image: Saint Lazare, Quebec by potentialdoctor.com

Clerkship Update: OBGYN Part 2

My very first clerkship rotation was in OBGYN outpatient clinics which I posted about here including some tips for surviving clerkship in general. This past month was a continuation of my OBGYN experience. The first 3 weeks were based in the birthing center where I had the opportunity to take part in a variety of interesting tasks:

  • Interview and examine pregnant patients in triage
  • Assist with vaginal deliveries and C-sections
  • Round on post-partum patients
  • Conduct consults in the ER

My last week was Gynecology-based where I got to assist with some gynecology surgical procedures in the OR, round on post-op patients, see patients in Gynecology/Early Pregnancy clinics and conduct consults in the ER.

What I enjoyed most:

I very much enjoyed interacting with pregnant patients and helping them through the beautiful, life-changing experience of welcoming their child into the world. I was also grateful to come out of this rotation with tangible, practical skills like delivering babies and suturing.

What I struggled with most:

The environment was fast-paced and quite stressful. It was difficult seeing patients experience pregnancy loss, particulary having gone through the experience myself. The schedule was exhausting with evening/night shifts and 2 weekends back-to-back. I definitely struggled with balancing work and family life and missed the kids a lot.

My take home message:

OBGYN is a great speciality in many ways. There is plenty of variety in terms of the work, it is rewarding bringing babies into the world and being a part of patients lives during such critical moments. For me personally, the demanding lifestyle was not a good fit for my family life, but I am grateful for all that I learned during this rotation and that it helped to clarify my interests more definitively.

Feature image photo credit: advocarepremierobgyn.com

Clerkship Update: Medical Genetics

I just completed my 2-week rotation in Medical Genetics and it was an incredible experience. My first week consisted of clinics where I got to meet pediatrics patients with a variety of genetic conditions. During my second week, I was assigned to the in-patient service where we were consulted  by the neonatal and pediatric Intensive Care Units to evaluate newborns and toddlers.

What I enjoyed most: 

This is a very intellectual specialty that requires extensive reading around cases. I very much enjoyed coming up with a differential diagnosis of possible conditions. The best part of this rotation was getting to spend an hour or more with each patient as we require much of this time to work through family histories in great detail as well as conduct a very thorough physical exam looking for dymorphologies, skeletel dysplasias, and any other abnormalities that could signal a possible genetic condition. I also appreciated refreshing my knowledge about the different types of Genetic testing such as FISH (Fluorescent In Situ Hybridization), aCGH (array Comparative Genomic Hybridization) and karyotyping.

What I struggled with most:

There is a vast amount of information to know in Genetics such as various syndromes, which definitely poses a challenge! Genetics deals mostly with diagnoses and counselling of patients. Although being able to provide a diagnosis for a child’s condition was very satisfying and would assist parents in learning how to manage the condition going forward, it was also emotionally challenging to not have a cure or solution for their condition. I wished there was more I could do for these families!

My take home message: 

This rotation increased my knowledge and understanding of congenital conditions which I feel will be important to consider when  assessing patients in the future. Medical Genetics is a fascinating field and this rotation increased my appreciation for the molecular intricacies of the human body. It was also humbling to witness how just one single DNA mutation could result in severe disease. It reminded me that having good health is something we cannot take for granted.

Featured image: Plethrons-Basics of DNA

Clerkship Update: Pathology

I just completed my 2-week rotation in Pathology and I really enjoyed it. My days consisted of a variety of activities such as grossing specimens in the lab (that is, examining and cutting them in preparation for creating microscopy slides), looking at slides under the light microscope and electron microscope, plenty of studying as well as attending autopsies, tumor boards and rounds. I also had the opportunity to observe intraoperative consultations which is when a surgeon excises a sample during a surgery and asks the pathologist to make a quick slide (better know as a “frozen” section) in order to have a preliminary diagnosis, usually in the context of cancer.

What I enjoyed most: 

First of all, I think microscopes are just so cool! Secondly, I had a fantastic team to work with! I also liked the flexibility and variability of the day with a lot of autonomy and self-directed learning.  For example, my main interests for this rotation were renal and gynecology pathology so I was able to tag along with the residents and staff physicians specializing in these areas.  I particularly enjoyed “sign-outs” when the staff, resident and I would sit at the teaching scopes (several microscopes connected to a main one so that you are all viewing the same slide) as this is where you get a lot of useful teaching on how to identify various structures. I also really appreciated that I got to brush up on my anatomy! The schedule was fairly light and I got to see my kids more often than in other rotations which was great!

What I struggled with most:

I missed patient contact and also sometimes felt helpless in cases where we diagnosed cancer since the clinical management is not done by the pathologist.

My take home message: 

I think Pathology is a great rotation for  medical students to consider regardless of your interests because it exposes you to a different side of medicine and will increase your understanding of various disease processes which is very useful to know in the clinical world. For example, I now have a much better understanding of glomerulonephritis, nephrotic syndromes and gynecology-related cancers. I also have a much better idea of how to interpret pathology reports and the amount of work that goes into creating one! I would currently rank Pathology as a “medium” as a future potential specialty for me because I still have to reconcile the fact that there is not much in the way of patient contact. However, it really resonated with me in terms of the intellectual aspects and I loved the detective work behind it.

My next rotation is an elective in Medical Genetics which sounds fascinating! Stay tuned!

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My assigned desk…reading up on some renal!
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My little monkeys climbing trees in the backyard. Love them to bits!

Featured image: lookfordiagnosis.com

Clerkship Update: Neonatal Intenstive Care Unit

I recently completed my 2-week rotation in the Neonatal Intensive Care Unit and it was a fantastic experience. The format of this rotation was such that medical students were integrated as part of the NICU team, attending sign-outs, rounding on patients, managing patients (physical exams etc), writing admission notes, progress notes and discharge summaries. We also took part in consults from the Obstetrics department and observed the resuscitation team who were prepped and ready for babies delivered by C-section.

What I enjoyed most: On this rotation, I had the wonderful opportunity to work with a a great team of staff physicians, residents, international medical students, nurses, nurse practitioners, nutrionists as well as various consultants. I very much enjoyed the teamwork! And of course,  I loved the patients (the babies) who were the real heros of the unit. I also really appreciated that we were assigned our own babies to manage and this afforded us plenty of autonomy and self-directed learning. On most days, we also had about 1 hour of teaching which was very beneficial.

What I struggled with most: Having to present my patients on rounds was quite intimidating some times but by the end of the 2-weeks, I felt much more confident, even if my management plans were sometimes off-track!

My take home message: The NICU was a fantastic experience and my favorite rotation so far. I am yet to do my core pediatrics rotation but I certainly enjoy working with the pediatric population. Since I also enjoy working with adult patients, I would currently rank pediatrics as a “medium” on a scale of low-medium-high, as a future potential specialty for me.

My current rotation is an elective in Pathology which has been very interesting and a different pace from clinical rotations. I will share my experiences on this in the coming weeks!

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Hubby and I on a date. We went on a nice long walk up Mont Royal, had lunch at a new vegetarian restaurant and went to see Mission Impossible: Fallout. We had a blast!
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We saw this piece of artwork on a park bench and thought it was quite unique (plus I had to take a picture of it for my daughter who loves giraffes!)

 

Clerkship Update: OBGYN reflections and tips

It has been 3 weeks since I started clerkship and it is going very well so far. I started off with Obstetrics/Gynecology outpatient clinic where I had to give two presentations on cases I encountered during the rotation. I was also exposed to various diverse clinics:

  • Obstetrics: following pregnant women at various stages of their pregnancies, interpreting prenatal screening tests, measuring fundal height, finding the baby’s heart beat with doppler ultrasound (one of my favorite parts of this rotation!) and taking GBS samples
  • Gynecology: managing endometriosis, menorrhagia, performing pap tests and colposcopy
  • Gynecology-Oncology: managing patients undergoing treatment for ovarian cancer
  • Diabetes: managing pregnant patients with Diabetes Type 1, Type 2 or Gestational diabetes
  • Fertility clinic: managing patients trying to conceive via IVF or IUI.
  • Ultrasound: observing the routine ultrasounds for pregnant patients performed at 12 and 20 weeks of pregnancy as well as measuring nuchal translucency.
OBGYN 2
Photo credit: parentmap.com

My reflections on this rotation: I found this to be a generally fast-paced,diverse environment with plenty of opportunities to do some procedures.

What I enjoyed most: I very much enjoyed the patient contact and sharing the joy of pregnant mothers awaiting the arrival of their little ones. I also enjoyed the clinics where I had the most autonomy to interact with patients on my own. My favorite clinic of the rotation was without a doubt Obstetrics!

What I struggled with most: There was a steep learning curve as I generally only spent one day in each clinic and every clinic runs differently. I had to learn to adapt quickly.

My take home message: I  learned so much from this rotation and felt that I improved in my history-taking and charting skills. I will wait until my OBGYN inpatient rotation to make a final decision about choosing this specialty but on a scale of low-medium-high, I would put Obstetrics and Gynecology as a “low” because I have much less of an interest in Gynecology than Obstetrics and there are alternative routes to practising Obstetrics (more on that later!).

My coping strategies on rotation:

  • I have a 2.5 hour daily train-commute which can be exhausting but I am using this time to study, read my Bible, decompress after a long day and also to read other topics/books that are of interest to me.
  • I make use of technology to stay in touch with my family and keep connected. For example, since I have to leave very early in the morning before anyone is awake, I Face-Time my hubby and kids every morning once I arrive at the hospital so I can see their adorable faces before I start my day. This is so energizing for me!
  • I have some prayer time during my 10-minute drive from my home to the train station (and on the way back as I reflect on my day). This plus reading my Bible on the train daily has kept me in a very positive state of mind despite feeling physically exhausted.
  • I aim to complete my reading/studying on the train so that once I am home, my focus is fully on my family.
  • It is challenging to find time to exercise so I wake up 15 minutes earlier every 2 days to have a short workout and then have my longer 35 to 45 minute workouts on the weekend.
  • Stay well hydrated and fed throughout the day. I carry granola bars in my white coat pocket or scrubs and carry around a bottle of water when feasible. This does wonders for your energy levels!
  • I had one particularly bad day last week where I felt extremely tired and did not feel my performance on rotation that day had been good at all. We have to remember that despite the really difficult days, there are better days to look forward to and it is all part of the learning process as we hone our skills.

I am currently on rotation in the Neonatal Intensive Care Unit and it has been both challenging and fantastic! I can’t wait to share with you my experiences on this rotation over the coming weeks!

Feature image photo credit: advocarepremierobgyn.com