Clerkship Update: Palliative Care

I had an incredible experience on my palliative care rotation. Going into it, I wasn’t sure what to expect. Whenever I informed people what rotation I was in, many wrinkled up their faces and said, “Ooh, it’s got to be depressing being around so many dying people”.

I have to say that my experience was quite the opposite. It is a different way of practicing medicine. Rather than focusing on curing a patient, one is focused on making them as comfortable as possible as they navigate the last months, weeks, days, hours and seconds of their lives. I found it a true privilege to accompany people on this journey.

I very much enjoyed how much time I got to spend with each patient and their families on a daily basis. It was certainly never easy discussing a short prognosis but in some ways, families found relief in having an idea of their loved one’s trajectory and in knowing they would be kept as comfortable as possible. The main things that impact heavily on dying patients, particularly in the context of terminal cancer, are pain, nausea, lack of appetite and a progressive sense of loss as they decline in function. Although it can be  difficult to do much about the loss of function, it is staggering to see how much better a patient feels when their pain and nausea can be controlled.

On this rotation, I worked with an excellent interdisciplinary team of doctors, nurses, social workers, PABs and art therapists.  I was truly inspired by their dedication and compassion for our patients.  I certainly struggled with my emotions when I lost a patient (which was almost on a daily basis) especially seeing the profound impact on the family members left behind. I truly treasure the meaningful connections I had with patients and their families on this rotation.

I also had the opportunity to participate in home visits. There was something especially touching about being able to go into a patient’s home and deliver care to them in an environment where they feel most at home.

Overall, my palliative care rotation was one of my best experiences in medical school. I encourage medical students out there wondering what electives to take to strongly consider taking it. It will change your perspective on life.

As my fourth year of medical school continues, I feel my confidence as a doctor-in-training progressively growing. There is still so much to learn of course. One of the great things about medicine, is the challenge of constantly growing and learning new things. As I ponder the current stage in my training, I am so grateful to be on this path to becoming a doctor, as difficult and challenging as it can be.

Featured image courtesy of https://www.medstarfranklinsquare.org

Clerkship Update: Urban Family Medicine

Clerkship Updates! I have just completed a month in Urban Family Medicine and I absolutely loved it! It definitely solidified my interest in and passion for Family Medicine. Most of my days were spent at a private Family Medicine clinic. I also spent time at a Dermatology, ENT and walk-in clinic, a senior’s residence and palliative care center.

What I learned from this rotation

This rotation was fantastic! There was frequent, useful one-on-one teaching and feedback which helped me to grow in my knowledge and clinical skills. I was constantly challenged to think more and more independently. I had the opportunity to manage complex patients and multi-complaint visits. I developed some new skills/knowledge in Dermatology, ENT and how to manage geriatric patients.

What I enjoyed most

I very much enjoyed the one-on-one teaching, the positive learning environment, the variety of cases I saw and the variety of work environments. I loved interacting with the patients and looked forward to going to work each day!

What I struggled with the most

The greatest challenge for me on this rotation was coming up with management plans for the more complex patients. However, by the end of the rotation, I felt that I had a better grasp of how to do this.

My take home message

Urban Family Medicine was a fantastic rotation and was definitely one of my favorite rotations. I loved the variety of cases I saw, interacting with patients of different ages and  getting to see patients who have been followed by the same physician for years and who know their patients very well. I also enjoyed the flexibility and variety of work environments. I really look forward to a future practice in Family Medicine!

Next rotation….Out-Patient Psychiatry. Stay tuned!

Featured image: Family photo 2017

Clerkship Update: Pediatrics Inpatient

Clerkship updates! I just completed a 4-week rotation on the pediatric wards and it has been one of my favorite rotations so far! My schedule consisted of 2 weeks of day shifts and 2 weeks of evening/night shifts plus 2 weekends. During the day shifts, my day consisted of teaching sessions/lectures, rounding on patients, writing progress notes and discharge summaries. My night shifts mostly consisted of admitting patients to the ward and writing admission notes. I also spent one amazing afternoon in the newborn nursery where I had the opportunity to refine my skills in conducting a newborn physical exam.

What I enjoyed the most

I very much enjoyed working with children of all ages and worked with a fantastic team of staff physicians and residents from different specialties (pediatrics, family medicine and pediatric neurology). There was also excellent teaching during this rotation with plenty of support. I felt I grew in my history taking, physical exam skills as well as coming up with a differential diagnosis and management plan. I felt that having had my own children really helped me communicate with young children and relate to the anxieties that parents have about their sick children. Also, although I used to dread the night shifts, I decided to change my attitude about it and focus on the positive aspects of working at night such as avoiding rush-hour traffic and getting to spend the mornings with my children, go on walks with them, or surprise my son at school at lunch time.

What I struggled with the most

My greatest challenge during this rotation was having to communicate in French. Many of the patients and families I encountered were Francophone and did not speak much English so I was forced to put my French language skills to the test! It was not easy getting a history or communicating plans to families in French but it certainly gave me plenty of practice! I definitely feel that I am improving!

My take home message

Pediatrics is a fantastic field if you love children and interacting with families as a whole. I also find the environment to be very positive and supportive! When it comes to night shifts, working strange schedules in medicine can be a challenge both mentally and physically. However, trying to find ways to adapt, adopting a positive mindset and getting creative with our time can ease the strain and pleasantly surprise us!

This ends my very first block of third year!  I am very excited to be starting my rural Family Medicine rotation next! Stay tuned!

Featured image photo credit: lakeviewpediatrics.net

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: 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!)

 

Excited…Tomorrow is the Start of Clerkship!

Tomorrow marks the first day of the next phase of my medical training…clerkship rotations! I am filled with excitement…if not a little nervous! I am so grateful for the wonderful summer break I have had with family and friends. I felt the bond with my kids growing especially strong over this summer and despite the usual challenges of parenting that sometimes leave me wanting to pull my hair out, it has been such a joy to see them thrive!

Knowing that our lives are about to get very busy with me working long hours at the hospital and a lengthy commute, I sat the kids down to let them know that they will not see mummy as often. They were sad but said, “We’ll miss you but we’ll always love you!” This really warmed my heart, especially with how attached I am to my kids!

I know there will be days when I question whether my absence is detrimental to their well-being. I know there will be days when my heart is aching to be with them. But I am trusting that they will be well and that I will not give in to the overwhelming feelings of mummy guilt. I am so grateful for my wonderful husband who I know will take excellent care of them when I’m not there.  I pray for God’s grace to continually strengthen our family through this new phase of our lives.

To my dearest hubby and children, I love you dearly. It is truly a joy to be going through life with you all by my side!

So, onward we go to clerkship! Thrilled to be starting with Obstetrics!

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Last week of vacation before clerkship starts tomorrow!

The First Year of Medical School…Done!!!

The past few months have been both challenging and amazing! I can’t quite believe that the first year of medical school is already done! It went by so quickly and I am amazed at how much I have grown and learned over the past year. We covered 8 blocks: Public Health, Respiration, Circulation, Renal, GI, Defense, Infection and the Musculoskeletal System.

The last block was particularly heavy in anatomy and one of the most challenging blocks I have done. I have to say that it brought me to a whole new level of appreciation for the human body as we learned over 1000 new terms for different muscles of the body in Latin. Difficult to do but also fascinating and rewarding! I am also gaining valuable ultrasound skills and have signed up to teach this to first-year medical students. I think it’s going to be a fantastic experience.

Throughout this past year, I have grown in my appreciation for my teachers, mentors, classmates, our silent “teachers” in the anatomy lab, and of course, the patients who I have had the privilege of interacting with. Our medical school curriculum is hands-on so we have had several opportunities to gain exposure in the clinical setting.

My favorite block so far was Defense (the Immune system). I loved learning about the various ways the body keeps foreign invaders in check. Truly a marvel of the human body and a beautiful reminder of the majesty of God’s creation.

Other exciting events that happened in the last few months:

  1. The celebration of our 10th wedding anniversary (happy anniversary to my dearest hubby!)
  2. My son’s completion of kindergarten and “graduation” to Grade 1 (that’s my boy!)
  3. My big brother’s graduation from medical school as he embarks on his pediatrics residency (so proud of you!)

How was the first year of medical school? It was about as challenging as I expected it to be (particularly when trying to balance the voluminous amount of material with family life, church activities, extracurriculars etc.) but it was even better than I imagined in terms of how interesting the material was and what a privilege it is to be a part of the medical profession.

Through it all, I couldn’t have done this without the grace of God, and the wonderful support of my amazing husband, kids, friends and family. I am looking forward to the summer break over the next 2 months, spending more time with my family and getting some rest. In late August, I will be starting my last two blocks of the Fundamentals of Medicine and then Transition to Clerkship (rotations) in January 2018. Exciting!

Time will continue to pass regardless of what you are doing….make sure you are doing what you love! It makes life more meaningful and full of purpose!

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Studying on the deck during final exam week
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A visit to Ann Arbor, Michigan for my brother’s graduation from medical school
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Daddy and his little girl, hand-in-hand. A visit to Quebec city to celebrate our 10th wedding anniversary.
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Our cutie-pie! A visit to the Aquarium in Quebec city.
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A beautiful view of Le Chateau Frontenac in Quebec City from the rotating restaurant Ciel! 
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Ready for summer fun! So blessed to have these little ones in my life!